Cervical Cerclage: Types, Procedure, Risks, Precautions and Recovery

Cervical cerclage is a procedure used during pregnancy to help prevent the cervix from opening too early. It may be recommended for women who have cervical insufficiency or are at increased risk of second-trimester pregnancy loss or spontaneous preterm birth.

For women looking for reliable pregnancy care and gynaecological care, understanding cervical cerclage can help them make informed decisions with their obstetrician. This article explains what cervical cerclage is, why it is performed, its different types, procedure, precautions, risks and stitch removal.

What Is Cervical Insufficiency?

Cervical insufficiency occurs when the cervix begins to shorten or open prematurely during pregnancy without the usual signs of labour.

It may increase the risk of:

• Second-trimester pregnancy loss
• Premature birth
• Early cervical dilation
• Premature rupture of membranes

Women with a previous pregnancy loss or spontaneous preterm birth may require closer monitoring of cervical length during pregnancy.

Types of Cervical Cerclage

There are two main types of cervical cerclage.

1. Transvaginal Cerclage

Transvaginal cerclage is the most commonly performed type of cervical cerclage. The obstetrician places the stitch around the cervix through the vagina.

It is generally performed during pregnancy when there is an appropriate medical indication.

2. Transabdominal Cerclage

Transabdominal cerclage involves placing the stitch around the cervix through an abdominal approach. It may be performed using open surgery or minimally invasive techniques such as laparoscopy in selected patients.

This approach may be considered when a transvaginal cerclage is not technically suitable or when a previous vaginal cerclage has not provided the desired outcome.

Why Is Cervical Cerclage Performed?

An obstetrician may consider cervical cerclage in selected high-risk pregnancies, including:

• A previous second-trimester pregnancy loss associated with painless cervical dilation
• A history of spontaneous preterm birth with cervical shortening in a subsequent pregnancy
• Significant cervical shortening identified on ultrasound in an appropriate clinical setting
• Cervical dilation found during examination before viability in selected circumstances
• Certain structural or surgical changes involving the cervix

Cerclage is not required for every woman with a short cervix. Your doctor will consider your complete pregnancy history, ultrasound findings and other risk factors before recommending treatment.

When Is Cervical Cerclage Performed?

The timing depends on the reason for the procedure.

A planned or history-indicated cervical cerclage is commonly performed around 12 to 14 weeks of pregnancy.

An ultrasound-indicated cerclage may be considered later if cervical shortening is detected in a woman with an appropriate history.

An examination-indicated or emergency cerclage may sometimes be considered when the cervix has already started opening, provided there are no contraindications such as active labour, significant infection or certain pregnancy complications.

Your obstetrician will determine the safest timing based on your individual condition.

How Is Cervical Cerclage Performed?

Before Cervical Cerclage

Before the procedure, your doctor may review:

• Previous pregnancy and delivery history
• Previous miscarriages or preterm births
• Cervical length measurements
• Ultrasound findings
• Symptoms such as bleeding, contractions or pelvic pressure
• Signs of infection

A pelvic examination and transvaginal ultrasound may be performed when clinically appropriate.

During the Procedure

Cervical cerclage is usually performed in a hospital or surgical setting under appropriate anaesthesia.

For a transvaginal cerclage, the patient is positioned similarly to a routine gynaecological examination. The surgeon places a strong suture around the cervix and tightens it to provide additional support.

The exact technique and duration of the procedure depend on the type of cerclage and the patient’s condition.

After the Procedure

After cervical cerclage, you may be monitored for a few hours before going home, depending on your medical condition.

Some women may experience:

• Mild abdominal or pelvic cramping
• Light vaginal spotting
• Mild discomfort

These symptoms are often temporary, but you should contact your doctor if they become severe or persistent.

Precautions After Cervical Cerclage

Your doctor will provide individual instructions after the procedure. General precautions may include:

• Take adequate rest immediately after the procedure as advised.
• Avoid strenuous exercise and heavy lifting until your doctor permits it.
• Follow your doctor’s instructions regarding sexual activity.
• Use sanitary pads instead of tampons if you experience spotting.
• Stay adequately hydrated.
• Attend all scheduled antenatal and follow-up appointments.
• Report unusual pain, bleeding, contractions or fluid leakage promptly.

Strict bed rest is not routinely recommended for every woman after cerclage. Activity restrictions should be based on your individual medical condition and your obstetrician’s advice.

Risks and Complications of Cervical Cerclage

Like any medical procedure, cervical cerclage has potential risks.

Possible complications include:

• Infection
• Vaginal bleeding
• Cervical injury or scarring
• Premature rupture of membranes
• Uterine contractions
• Preterm labour
• Difficulty during stitch removal
• Rare complications related to anaesthesia or surgery

Your doctor will explain the expected benefits and potential risks before the procedure.

When Is Cervical Cerclage Removed?

For most transvaginal cerclages, the stitch is usually removed around 36 to 37 weeks of pregnancy, before labour begins.

However, earlier removal may be required if there is:

• Active labour
• Significant vaginal bleeding
• Suspected infection
• Rupture of membranes
• Another medical reason requiring delivery

Transabdominal cerclage is managed differently. The stitch may remain in place and delivery is generally planned by caesarean section.

When Should You Contact Your Obstetrician?

After cervical cerclage, contact your doctor promptly if you experience:

• Fever or chills
• Regular contractions
• Increasing abdominal or pelvic pain
• Heavy vaginal bleeding
• Foul-smelling vaginal discharge
• Leakage or a sudden gush of fluid
• Severe pelvic pressure
• Any concerning change in pregnancy symptoms

These symptoms may require urgent medical assessment.

When to Consult a Gynaecologist or Obstetrician

If you have experienced previous pregnancy loss, spontaneous preterm birth, cervical shortening or early cervical dilation, discuss your pregnancy history with a qualified gynaecologist or obstetrician.

Early pregnancy assessment and appropriate antenatal monitoring can help identify women who may benefit from additional care.

Conclusion

Cervical cerclage is an important treatment option for selected pregnancies at increased risk of cervical insufficiency and preterm birth. Understanding the types of cervical cerclage, procedure, precautions, risks and removal timing can help expectant mothers feel more prepared.

Every pregnancy is different. If you are concerned about cervical weakness, previous pregnancy loss or the risk of premature birth, consult your gynaecologist or obstetrician for personalised medical advice and pregnancy care.

For a Gynaecologist or Obstetrician and emergency assistance, contact Akshar Hospital at 079 2682 2254 or 8511557873.