A woman has a long, firm and close cervix before pregnancy. But during pregnancy, the cervix gets soft, decreases in length and opens till the end of the term in preparation for birth.
If you have cervical incompetence, weakened or short cervix then the cervix begins to open too early.
Cervical incompetence is a condition in which there is impairment of the retentive power of the cervix due to congenital (rare) or acquired (D & E operation, vaginal operative delivery in undilated cervix and induced abortion) conditions cause painless dilation of the cervix in the second and third-trimester results in pregnancy loss and premature birth.
To prevent miscarriages and preterm labour, a cervical cerclage operation can be performed by the doctor to keep the cervix closed.
What is cervical cerclage operation?
Cervical cerclage, also known as a cervical stitch is a surgical procedure in which a non- absorbable encircling suture is placed around the cervix at the level of the internal os (upper part of the cervix). The stitch sews the cervix closed.
It is an operative procedure done at the hospital usually through the vagina and less commonly through the abdomen.
What is the most appropriate time of operation?
The procedure should be done around 14 weeks of pregnancy or at least two weeks earlier than the previous wastage, as early as the 10th week.
In some cases, an operation is done after inspecting the cervix through the speculum and as soon as cervix dalitation or bulging of the membranes is visible.
It is very necessary to assess the fetal growth and development prior to the operation by sonography.
What are the risk associated with cerclage operation?
The risk associated with cerclage operation includes-
- Vaginal bleeding
- Preterm premature rupture of the membranes
- Cervix tear
- Fetal membranes inflammation due to invasion of infection during procedure
- Displacement of the suture
- Preterm labour
What are the types of cerclage operations?
There are mainly two types of operations are in current use during pregnancy and both have an equal success rate of about 80%.
The operations include Shirodkar’s operation and McDonald’s operation.
What can you expect from the procedure?
The procedure is usually done by the doctor in an operating room of the hospital.
During the procedure
During transvaginal cerclage operation, the doctor may use a vaginal speculum and insert it into the vagina and the cervix is grasped and pulled down by sponge holding forceps.
During Shirodkar’s operation, an incision is given below the base of the bladder on the vaginal wall and the bladder is pushed up to expose the upper part of the cervix. A small incision is given in the cervix where it meets the vaginal tissue. The suture material is passed with the help of a cervical needle to bring the suture ends through the incision. Lastly, the ends of the suture are tied up and incisions are repaired.
During McDonald’s operation, the suture material is placed as a purse-string suture as high as possible at the junction of the vagina and cervix. Two ends of the suture are tied to close the cervix.
After the procedure
After placing a cervical stitch, you may experience mild cramping, spotting and pain while urination. You must be in bed for at least 2 to 3 days and the doctor may prescribe an isoxsuprine tablet to avoid uterine irritability.
Ultrasound may be done by the doctor to check the fetal condition and the cervix periodically.
The woman is advised to avoid sexual intercourse and a rough journey. She is also advised to report to the doctor if there is any unusual vaginal bleeding or abdominal pain occurs.
Removal of the stitch
The cerclage stitch should be removed at the 37th week or earlier if the labour pain starts. There are chances of uterine rupture or cervical tear if the stitch is not cut in time.
If you had any cervical cerclage operation failure and pregnancy loss then you should wait for at least six months to give time to your body to recover completely and then plan another pregnancy. You may need another cervical stitch to prevent abortion and pregnancy loss in the future.
In the above post, we discussed the cervical cerclage operation to prevent pregnancy loss and preterm delivery.