What is the Cervical Cerclage?
A cervical cerclage, also known as cervical stitch, is a minor surgical procedure that is applied to deal with cervical incompetence in which the cervix opens too soon during the prenatal period. The condition makes the cervix incapable of remaining closed throughout pregnancy. The cervix refers to the lowest part of the uterus. A pregnant woman with this abnormality must undergo a cervical cerclage to have her cervix stitched closed to prevent the weak cervix from opening early. Keep in mind that an incompetent cervix can lead to a risk of premature birth if untreated.
How to Perform the Surgical Procedure
If you have an incompetent cervix, you have to receive general or regional anesthesia (spinal or epidural injection) with this procedure. A spinal injection uses anesthetizing medications in which a needle is inserted into an area between the vertebrae. Meanwhile, an epidural injection uses a catheter instead.
There are two common types to perform this procedure:
• The McDonald type includes a band of suture at the upper part of the cervix. Your physician will position this cerclage between 12 weeks and 24 weeks of pregnancy.
• The Shirodkar type includes a band of suture passing through the cervical walls. This procedure applies a permanent stitch around the cervix so that a Caesarean section is essential when it comes to delivering the baby. The Caesarean section allows the baby to come out through an incision in your uterus and abdomen.
Removal of Cervical Cerclage
When you reach 37 weeks of pregnancy, cervical cerclage removal can be performed if the McDonald type is applied. Your physician can also recommend removing most stitches when contractions begin. Nevertheless, if you have a cerclage in one pregnancy, you will be likely to have another cerclage in future pregnancy.
Who Performs the Procedure?
An anesthesiologist will perform anesthesia, while a gynecologist or an obstetrician can perform the cerclage. A gynecologist is a trained physician who focuses on the health of female reproductive systems. An obstetrician is a professional physician who specializes in dealing with labor and childbirth.
Risks and Complications
Despite being considered a safe procedure, risks and complications can happen during and after surgery including:
• Excessive hemorrhage
• Cervical infection and injury
• Premature labor
• Uterine rupture
• Amniotic sac infection (chorioamnionitis)
• Cervical laceration if labor occurs before removing the cerclage
• Failure of the cervix to distend normally when labor occurs (cervical dystocia)
• Permanent closure of the cervix (cervical stenosis)
Having the cerclage positioned, you might have light blood loss followed by thick vaginal fluid that will end after a few days. In addition, you must stay in the hospital for at least several hours or overnight to ensure that you will not experience premature contractions or labor.
You will then be able to come home, but you need to be on bed rest and keep away from physical activity for two to three days after the surgery. Your physician will tell you when to do your regular activity. It is always recommended that you abstain from having sexual intercourse at least one week after the procedure.
Encyclopedia of Surgery: Cervical Cerclage - https://www.surgeryencyclopedia.com/Ce-Fi/Cervical-Cerclage.html
American Pregnancy Association: Cervical Cerclage - https://www.americanpregnancy.org/pregnancycomplications/cervicalcerclage.html
MSN.com: Cervical Cerclage to Prevent Preterm Delivery - https://health.msn.com/pregnancy/articlepage.aspx?cp-documentid=100068193
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