Cervical Cerclage is the closing of the cervix – the lower part of the uterus that opens to the vagina – via stitching. This surgery is performed during pregnancy to prevent premature birth or miscarriage.
Cervical Cerclage is the closing of the cervix - the lower part of the uterus that opens to the vagina - via stitching. This surgery is performed during pregnancy to prevent premature birth or miscarriage.
Cervical Cerclage can be performed in 2 ways:
Transvaginal Cervical Cerclage - Procedure is conducted through vagina
Transabdominal Cervical Cerclage - Procedure is performed via abdomen
Your gynaecologist might recommend cervical cerclage in either of the following cases:
Cervix opens too early or has the risk of opening prior to the baby getting ready for birth
Cervix has been previously subjected to surgery
History of late miscarriage(s)
History of second trimester pregnancy loss
In case of cervical dilation - when amino sac protrudes from the cervix - Cervical Cerclage can be performed in emergency.
In ideal scenario, cervical cerclage is perfomed between 12 to 16 weeks of pregnancy. However, in case of emergencies, the procedure can be performed upto 24 weeks of pregnancy.
Before cervical cerclage is performed, your doctor will do the following:
Check your medical history.
Conduct an ultrasound to check the vitals of the baby and ensure there are no major birth defects checked via ultrasound.
Examine your cervix - whether it has already started to open or is too short. In either case, medication will be prescribed.
Might do Aminocentesis to check for infection.
For prolapsed fetal membranes, your doctor will first treat the condition by placing catheter (a thin tube) in your urethra and repositioning the amino sac. In some cases, balloon catheter is also insterted to reposition the amino sac.
Cervical Cerclage will not be done when you have excessive vaginal bleeding, pre-term labor, infection of the utreus, leaky amino sac or risk of miscarriage due to abnormalities in the fetus.
Cervical cerclage is performed on the patient under regional or general anesthesia. The procedure can be transvaginal or transabdominal.
Transvaginal Cervical Cerclage - It is performed through the vagina. Your doctor will insert speculum in the vagina and use forceps to grab the cervix. Your doctor might use McDonald or Shirodkar technique to perform the procedure.
McDonald Cerclage: A band of suture is involved in the cervix-stitching. The circlage is put on the upper part of cervix when the effacing of the lower part has already begun. Usually the stitch is removed around 37th week of pregnancy.
Shirodkar Cerclage: Here the sutures pass through the cervix-walls. Sometimes in the Shirodkar Cercalge , a permanent stitch is made around the cervix; this will not be removed, and so the baby will be delivered via a Caesarian section.
Transabdominal Cervical Cerclage - If the cervix is short or damaged, then your doctor will perform the procedure through the abdomen. A cut is made in your abdomen and uterus is elevated to access the cervix. The doctor will close the cervix tightly by placing a tape around the passage connecting uterus and cervix. The uterus will then be settled to its original position.
After the procedure, your doctor will check the following:
Ensured that the patient does not undergo premature contractions or labour, by keeping the patient under observation for several hours, maybe overnight.
Baby’s health via ultrasound.
Medications will be prescribed for preventing infection. You might experience cramps, spotting and pain while urinating, for a few days.
Your doctor will recommend you to avoid unnecessary physical activity including sex for 5 to 7 days after the surgery. If you had cervical cerclage in emergency situation, then you will be recommended against any physical activity till the end of pregnancy.
There will be follow-up appointments for the doctor to monitor the cervix and do what is needed, including watching for indications of premature labour.
Risk and Complications
The following are a few of the possible risks and complications:
Damage to cervix during the surgery
Membrane - rupture
Cervical laceration in case labour takes place before the cerclage gets removed.
Cervical stenosis (Cervix is permanently closed or narrowed)
Vesicovaginal Fistula (Abnormal connection between vagina and bladder)
Displacement of cervix
The cost for this procedure is usually ranges between Rs. 30,000 and Rs. 50,000.
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