Cerclage

Cerclage is a surgical procedure used to close the cervix (the neck of the uterus, the female reproductive organ that houses the embryo and fetus during pregnancy). Cerclage is sometimes recommended for women who have an incompetent cervix.


Incompetent cervix and pregnancy
The cervix, which is about an inch long, provides an exit for tissue and blood during menstruation. During labor, the cervix effaces (thins) and gradually dilates (opens) to allow for delivery of the baby. If the cervix is incompetent, it may open during the second trimester or early part of the third trimester. This defect often leads to miscarriage or preterm birth and may be a risk with each pregnancy.
Risk factors for an incompetent cervix include:

injury to the cervix during a previous delivery, gynecological procedure or abortion
carrying multiple babies (The incompetent cervix isn't likely to recur if you're pregnant with a single child in the future.)
abnormal development of the cervix (This may occur due to exposure to diethylstilbestrol before birth. This synthetic estrogen was used to treat certain medical conditions in women from 1938 to the early 1970s.)

Purpose/indications
Cerclage is usually done after the 14th week of pregnancy to prevent the cervix from opening and causing a miscarriage during the second trimester or, sometimes, the third trimester. Cerclage may sometimes be done if there's advanced cervical dilation before the end of a pregnancy or the amniotic membranes (those that house the amniotic fluid, which protects the baby in the womb) are bulging into your vagina. The procedure shouldn't be done if you have vaginal bleeding, uterine cramps or an infection, or the amniotic membrane has broken.

Preparation
The doctor will review your medical history and do a physical exam. An ultrasound (using sound waves to create images of internal body parts) will be done to evaluate your baby's health and determine the baby's age. You may need lab tests to determine whether you have a vaginal infection. Any infections will be treated, and you'll also need general preparation for surgery. This typically includes lab work and a discussion of anesthesia.

Procedure
Cerclage is done in the hospital, typically under regional anesthesia, which numbs part of your body. During this procedure, the doctor will place a suture (a strong nonabsorbable thread) into the wall of the cervix and then sew the cervix closed. Sometimes, there are variations in the procedure. Ask your doctor for details.

Postprocedure care
Most women stay in the hospital for one day after surgery. Your doctor will determine when it's safe for you to resume normal activity. Intercourse is sometimes allowed several weeks after the procedure. In some cases, however, the doctor may recommend bedrest and no intercourse for the rest of the pregnancy. Close follow-up until the baby is born is essential.
If there's any indication that you're having a miscarriage or a premature delivery is imminent, the suture will be removed immediately. If the pregnancy progresses normally, the suture will be left in place until the 37th week of pregnancy. Labor and delivery often follow soon after the suture is removed. If the baby is delivered surgically through a cesarean section, the suture may be left in place for future pregnancies.


Benefits
Cerclage is successful in 80 to 90 percent of cases.

Risks
Possible risks include:
premature labor
hemorrhage (heavy bleeding)
infection
accidental rupture of the uterus or amniotic membrane and fluid
changes in the cervix that necessitate a cesarean delivery

Considerations
If you have an incompetent cervix but a low to moderate risk for premature birth, cerclage may not be necessary. If cerclage is indicated but can't be done safely, your doctor will prescribe bedrest.