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.
Pic courtesy: https://alittlebitofcancer.wordpress.com/tag/transabdominal-cerclage/
Types
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.
Indications
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.
Timing
- 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.
Complications
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.
Removal
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.