Is Cervical Cerclage Necessary During Pregnancy?
Some pregnant women have a weak cervix, so your doctor may suggest a cervical cerclage. It is a method to keep the cervix closed during pregnancy to prevent premature birth. But is a cervical cerclage necessary during pregnancy? This is what we will learn in the following lines, so stay with us!
What is Cervical Cerclage?
The cervix is the lower part of the uterus. A cervical cerclage is a method to keep the cervix closed during pregnancy to prevent premature birth due to a weak cervix.
In case of cervical insufficiency, your doctor is more likely to recommend a cervical cerclage to maintain the safety of the fetus inside the uterus until the time of delivery. This procedure can be performed before or during pregnancy, where your doctor sutures the cervix to close it with one or more stitches in the cervical opening and leaves it in place even after delivery by cesarean section.
The cerclage is usually removed vaginally around week 37 of pregnancy. An abdominal cerclage is usually left in place until delivery via cesarean section. An abdominal cerclage can also be left in place between pregnancies, to prevent future premature birth or pregnancy loss.
Steps of Performing a Cervical Cerclage
Initially, you will undergo general anesthesia, which will help you not feel any pain. The surgery is performed either through the vagina or abdomen:
Vaginally: This is the most common method for this procedure. Your doctor will use an instrument called a speculum to keep the vagina open to access the cervix. They then suture the cervix to close it.
Abdominally: You may need this surgery if you have had cervical stitches before that were unsuccessful or if the cervix is too short. Your doctor will make a small incision in your abdomen. They may need to lift the uterus upward to access the cervix and close it.
When is a Cervical Cerclage Performed?
If your doctor recommends a cervical stitch because you experienced problems in a previous pregnancy, it is best performed after 12 to 14 weeks of pregnancy.
If the procedure is performed after this time, it is called an emergency cervical cerclage. If you have had an emergency cervical cerclage, you have a higher chance of needing another cerclage if you become pregnant again.
Otherwise, you can undergo the surgery up to 24 weeks. After that date, a cervical stitch may lead to rupture of the amniotic sac and premature birth of your baby.
When Does a Pregnant Woman Need a Cervical Cerclage?
There are several reasons why your doctor may advise you to undergo a cervical cerclage during pregnancy. Some reasons may include:
Weak or short cervix (length less than 25 mm). This can occur due to previous surgeries such as: Loop Electrosurgical Excision Procedure (LEEP) or other surgeries on cervical tissues.
You have a history of miscarriages due to an abnormal uterine shape or cervical damage in the second trimester.
If your cervix begins to open in the second trimester with painless dilation.
If you have had a cervical cerclage in a previous pregnancy, especially after the fourteenth week.
Previous delivery before week 34 of pregnancy and the cervical length was short before week 24 of pregnancy.
Cervical injury resulting from one or more past abortion procedures.
What are the Risks of a Cervical Cerclage?
Your doctor will only recommend a cervical cerclage if the benefits outweigh the risks. But as with any medical procedure, there are some risks to be aware of when undergoing this procedure. These include:
Infection.
Bleeding.
Premature rupture of membranes. Rupture of your membranes can lead to premature birth.
Preterm labor.
Permanent narrowing of the cervix.
Scar tissue on the cervix.
Tear in the cervix or uterus if labor progresses while the stitches are still intact.
Is a Cervical Cerclage Necessary During Pregnancy?
A cervical cerclage is not necessary for every pregnant woman. It can only help women who have an abnormal or “incompetent” cervix.
However, even after performing a cervical cerclage, other problems can occur that lead to labor starting too early. Women who have undergone this procedure will need routine check-ups to ensure there are no other complications such as infection and preterm birth.
Is a Cervical Cerclage Painful?
It is normal to feel some cramping and light bleeding or spotting for a few days after the procedure. You should not feel severe pain after a cervical cerclage. But if you experience severe cramping or abdominal pain, contact your doctor immediately.
How Long Does a Cervical Cerclage Procedure Take?
A cervical cerclage procedure takes less than an hour, and you can return home on the same day. After the procedure, you will stay in the hospital for a few hours to ensure you have no complications. The doctor may give you an antibiotic to prevent any infection in the cervix.
What is the Recovery Period After a Cervical Cerclage?
The doctor will ask you to have complete bed rest for one to ten days after a cervical cerclage to allow time for the cervical stitches to heal properly. During this time, it is important for you to refrain from strenuous exercise or heavy lifting.
Is There an Alternative to a Cervical Cerclage?
If cervical changes are detected very late in pregnancy, or if the cervix has already opened significantly, bed rest may be the best alternative.
Precautions After a Cervical Cerclage
After a cervical cerclage, your doctor will advise you to rest for one to ten days to allow time for the cervical stitches to heal properly. During this time, it is important for you to follow some instructions:
Refrain from sexual intercourse or inserting anything into the vagina, such as douches or other feminine products.
Refrain from strenuous exercise or heavy lifting.
Drink plenty of fluids and make sure to keep your bladder empty.
Signs of a Successful Cervical Cerclage
Not all doctors agree on how successful a cervical cerclage is. If you have a weak cervix (cervical insufficiency) and have undergone a cervical cerclage, it is likely to reduce your chances of premature birth.
The success of a cervical cerclage largely depends on when it is performed. If it is performed as an emergency, when the cervix has already changed in size or shape, it is less likely to succeed.
Fetal Movement After a Cervical Cerclage
A cervical cerclage is completely safe for the fetus; nothing is done near the fetus. In fact, it increases the baby’s chances of survival because it reduces the chance of premature birth. However, you should monitor fetal movement during pregnancy after the procedure. If fetal movement stops, you should consult a doctor, as ignoring or not noticing the cessation of movement can cause many problems.