Cerclage is a procedure wherein a suture (stitch or tape) is placed around the cervix (neck of the womb) in a purse string manner to keep the mouth of the uterus (womb) closed and avoid miscarriage. The exact cause of premature labour or late miscarriages is not clear, but they may be caused by changes in the cervix such as shortening and opening. A cervical suture helps to keep the cervix closed.


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Cerclage may be done using a suture or a tape.

  • Vaginal route – McDonald or Shirodkar
  • Abdominal route – open or laparoscopy

Shirodkar or abdominal cerclage may be advised in women who had a previously failed McDonald cerclage.


Planned (Elective): Women with previous second trimester pregnancy losses or prior cervical surgeries such as conisation/LLETZ (history-indicated) or short cervix on ultrasound examination (USG-indicated).

Rescue (Emergency): When the cervix is found to be open incidentally and the bag of membranes is exposed to the vagina.


  • It is usually done after 3rd month scan (NT scan) between 12 to 16 weeks of pregnancy.
  • It can be done laparoscopically in the interval period between pregnancies.

Hospital Stay

It can be done under regional (epidural or spinal) or general anaesthesia. The hospital stay may be 12 to 24 hours for vaginal cerclage and up to 3 days following open abdominal cerclage.


During Procedure

  • Bleeding
  • Bladder injury
  • Rupture of membranes and fluid leak

Post Procedure

  • Risk of miscarriage/premature labour
  • Infection (more for rescue cerclage)

Post Cerclage Care

Bleeding can be expected for a few days after the procedure. Physical strain and sexual intercourse must be avoided in the initial few days of recovery. Complete bed rest is not recommended. Routine antenatal care should be continued as advised.


For Vaginal Cerclage:

The suture has to be removed at 36-37 weeks of pregnancy and vaginal delivery can be allowed.

For Abdominal Cerclage:

Delivery is by planned Caesarean section at 38 weeks and the tape may be left in situ for future pregnancies. Removal of the tape may be advised in cases of premature labour, leaking/bleeding per vaginum or fetal demise, which would require additional procedures under anaesthesia.

STEM CELLS – Frequently Asked Questions

Q. What are stem cells?
A. Stem cells are the master cells of our body from which all the other 250 types of cells are formed. The umbilical cord blood mainly contains hematopoietic or blood cell forming stem cells i.e., stem cells that form Red Blood Cells, White Blood Cells and platelets.

Pic courtesy:  http://nas-sites.org/stemcells/stem-cell-basics/download-stem-cell-figures/

Q. In what conditions can stem cells be used?
A. As of now, stem cells have been used to treat almost 70 blood related diseases. Some of them are blood cancers like Leukemia and Myelo-proliferative disorders, Inherited Red Cell abnormality like Thalassemia, Immune-deficiency disorders and inherited metabolic disorders.

Q. What is the difference between Public Cord Blood Banking and Private Cord Blood Banking?
A. In public cord blood banking, there is no cost to the family concerned. The family donates their baby’s cord blood to the bank for future use by any Indian, subject to HLA compatibility or for research purposes. The cells belong to the bank and the family has no claims on the cells.

In private cord blood banking, the family pays a fee for storing their baby’s cord blood ONLY for their future use. The cells belong to the family.

Q. What is the rationale for public banking?
A. When the stem cells are donated, these cells can be made available to anyone across the world who is a perfect HLA match. Hence the likelihood of usage is much more, especially for Indians in any part of the globe as these HLA proteins are similar in people of the same ethnic origins.

Q. Does collecting cord blood affect the baby?
A. No. Cord blood is collected only after the birth of the baby and after clamping of the umbilical cord. The baby is in no way deprived of blood as the routine process of delivery is not interfered with in any way.

Q. Does the cord blood collection harm the mother?
A. No, it does not harm the mother in any way. It is a completely safe, harmless and painless procedure.

Q. Can all pregnant women donate cord blood?
A. Every healthy pregnant woman who has a normal pregnancy and a healthy foetus can opt to donate the cord blood of her baby.

Q. Will a blood sample be collected from the mother?
A. Yes, a sample from the mother will be collected at the time of onset of labour.

Q. What is HLA testing?
A. HLA or Human Leukocyte Antigen testing is the test for specific proteins that are present on the surface of the leukocyte (white blood cell). If stem cells from one individual have to be used for another person, the HLA types of the donor and recipient need to match.

Pic courtesy: http://www.stemcellclinic.com/scientists-learned-how-to-expand-successfully-cord-blood-stem-cells/?lang=en

Q. How do I benefit from donating my baby’s cord blood?
A. Your cord blood donation will help the public cord blood bank to create a large inventory of tested stem cell units ready for transplant and thus increase the chances of finding a match. In the unforeseen event of any of your children needing a unit of stem cells for treatment of any haematological diseases, the public cord blood bank will make all efforts to find a best match available. In such an instance, you will only have to pay any additional testing charges and cost of transportation of the unit to the place of treatment.

Q. What are the chances that any one of us may need stem cells?
A. For a family to make use of the cells banked for itself, the likelihood varies from 1 in 400 to 1 in 200,000, as the usefulness is limited to the close family alone. Most of the childhood illnesses and cancers have a genetic basis and as the stem cells will carry signs of any genetic illness, the likelihood of the child using its own stored cells is also very remote.

Q. What happens if I donate to the public bank and then I need the stem cells myself?
A. If the cells you have donated are required for anyone else, the public bank shall issue these cells and keep you informed. If the cells are still with the bank, they will make them available to you at a concessional cost. This cost is for any additional testing and transport of the cells to the transplant site.

Q. What if there are twins?
A. Ideally, 70 ml or more cord blood is required to get adequate numbers of stem cells for transplant. In twin pregnancies, the volume of cord blood collected from each twin is appreciably less, as the weight of each twin is also less than an average weight of a newborn. Hence only in rare instances is cord blood collection in twin pregnancies encouraged.

Healthy Habits for Women to Start

Today’s women have become career achievers and also manage to cope with family responsibilities efficiently. However, they neglect health issues and seek help only when they have complications and medical conditions which are difficult to treat. Incidences of obesity, diabetes, hypertension, vitamin D deficiency, thyroid disorders, heart diseases and cancers have increased tremendously. Sedentary lifestyle, increasing stress and fewer children have contributed to rising health problems in women.


Pic courtesy:  https://www.focusforhealth.org/stay-informed-stay-healthy/


In the National Family Health Survey in 2007, Punjab ranked first in order of percentage of obese / overweight women with an incidence of 37.5% followed by Kerala at 34% and the erstwhile Andhra Pradesh at 22.7%.


Incidence of diabetes in Indian women is rising alarmingly. Approximately 29 million women are affected by high blood sugar. Women with diabetes still play a ‘caretaker role’ in the family and prioritise the health of others above their own. At a disadvantage compared to men, women have unequal access to resources preventing early diagnosis of the disease.


Since hypertension is easy to diagnose but not easy to treat, a few blood pressure recordings can confirm the disease and the treatment can be initiated early to prevent complications. The number of women affected by high blood pressure is very high – 17% as per one study in India and 22.6% in a WHO report on Indian women.

Vitamin D Deficiency

Vitamin D deficiency and reduced bone mineral density is widespread. Vitamin D deficiency is a common problem in India due to several factors:

  • Changing food fads and habits contribute to low dietary calcium and vitamin D intake.
  • With modernization, the number of hours spent indoors has increased thereby preventing adequate exposure to sun. This is particularly true in urban Indians.
  • Increased pollution can hamper the ultraviolet rays to adequately synthesize vitamin D in the skin.
  • Cultural and traditional habits prevalent in certain religions like “burqa” and the “pardah” have been well known to be associated with vitamin D deficiency.
  • Repeated and unplanned, and unspaced pregnancies in dietary deficient patients can aggravate vitamin D deficiency in the mother and the fetus.

Thirty minutes exposure of the skin on the arms and face to sunlight, without application of sunscreen, preferably between 10 am and 2 pm daily (as maximum ultraviolet B rays are transmitted during this time) is adequate to avoid vitamin D deficiency. An Indian study looked at 25-hydroxy Vitamin D and BMD in women of reproductive age group and post menopausal women in South India. They have reported vitamin D deficiency in 76% women of reproductive age, 70% in post menopausal women, and insufficiency in 16.5% in women of reproductive age and 23% in post menopausal women.

Thyroid Disease

Thyroid disease prevalence in women is high and the disorder mostly affects older women, especially the ones with hormonal imbalances, such as the one occurring around menopause, or during pregnancy etc. But in recent times, however, the incidence of thyroid disorders among urban women in their early 30s, has increased and is on the rise. Almost 30% – 35% of women belonging to this age group are affected.

According to clinical data, the current trend of abnormal thyroid status in younger women is because urban young women though highly educated, in an attempt to enhance their career or in order to follow the modern lifestyle, tend to neglect their health to a critical extent. Not only their diet is improper with deficiency in iodine, it is also unbalanced from the perspective of adequate and accurate nutrition. They also lack the required physical activity appropriate for their age.

While they are in hot pursuit of their career, leading to a stressful lifestyle, there sets in a scenario where these women tend to turn a blind eye to symptoms such as obesity, failure to lose weight, tiredness, bodyache, mood swings, excessive hairfall, balding scalp, irritability, menstrual disorders, difficulty in conception, repeated miscarriages etc., which typically point towards medical disorders, of which thyroid related ailments are the most common presenting with such symptomatology.

Diabetic women are more prone to a disturbed thyroid profile. Also, over-burden of toxins (endocrine disrupting toxins) caused by pollution through air, water, and food add to complications. An early diagnosis goes a long way in preventing these serious health disorders.

A change in lifestyle like a healthy diet, exercise, proper nutrition and stress reduction can help minimise the chance of developing thyroid disease. Sea kelp, selenium, flaxseed oil, zinc, multi-vitamins, etc can help in hypothyroid cases.

Heart Disease

Diagnosis of heart attacks in women is late because classic heart attack symptoms as in men are absent, but many experience vague or even “silent” symptoms which they will miss. There are six symptoms which are common in women –

  1. Chest pain or discomfort which may feel like a squeezing or fullness
  2. Pain in your arm(s), back, neck, or jaw
  3. Stomach pain
  4. Shortness of breath, nausea, or lightheadedness
  5. Sweating
  6. Fatigue

Heart disease is now the leading cause of death in women. There is a lack of information about the prevention and management of atherosclerotic heart disease in women from a range of communities that comprise the extremely diverse population of India. Westernization of Indian women has lead to smoking and alcohol addiction and this is also contributing to high cardiovascular disease in women.

Women and Cancer

Last, but not the least, incidence of cancer in women is on rise, and Indian women top the world with the highest number of cervical cancer deaths. Pap smear examination and knowledge about its value in detection of cervical cancer at the earliest is lacking. Experts say that now women marry late and give birth to fewer children, all of which leads to a dip in cervical cancer but rise in breast cancer.

Breast cancer is now more prevalent than cervical cancer. Educated as well as uneducated women lack knowledge about self breast examination and the awareness to seek help. Late marriages, fewer children, use of oral contraceptive pills, obesity, sedentary lifestyle and unhealthy eating habits are fuelling cancer growth in women.

Cervical cancer vaccine and Hepatitis B vaccine prevent cancers. Ask your doctor for vaccinations to prevent these cancers.

Now let us look at what every woman should do to look after themselves:

  • Weight should be checked every week. Maintaining body mass index of 23 is essential.
  • Exercise daily for 30 minutes. Household work is accustomed exercise and will not burn your calories.
  • Eat healthy; avoid high calorie carbohydrates, saturated fats. Increase vegetable intake and fruits in daily diet.
  • Check for thyroid swelling in the neck every day when you look into the mirror.
  • After the age of 30, get sugar, BP and thyroid tests done.
  • Every woman should get a Pap smear done 1 – 2 years after starting active sexual life. Getting cervical cancer vaccine before starting sexual activity is a very wise decision.
  • Self breast examination should be taught to every girl after attaining menarche (first menstrual period) and it should be done every month after bleeding stops.
  • Get your thyroids checked and diabetes risk checked before planning pregnancy.
  • Daily sun exposure for 30 minutes from 10 am to 2 pm will keep bones healthy. Drinking milk and taking calcium rich diet protects you from osteoporosis.
  • Yearly health checks and doctors consultation will go a long way in keeping healthy.


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A Healthy Woman Brings Up A Healthy Family!