Cervical cerclage/ Cervical Stitch/ OS tightening
Cervical cerclage, also known as cervical stitch, is a medical procedure used to reinforce and close the cervix during pregnancy to prevent premature birth or miscarriage. The cervix is the lower part of the uterus that opens and allows the baby to pass through during delivery. Sometimes, the cervix may become weakened or incompetent, leading to its premature opening and the risk of miscarriage or preterm labor.
The cerclage procedure involves the placement of sutures or stitches around the cervix to provide support and keep it closed. The aim is to reduce the pressure on the cervix from the growing baby and to prevent its early dilation. Cervical cerclage is usually performed during the first or early second trimester of pregnancy and is removed before delivery or during the onset of labor.
There are several types of cervical cerclage, and the choice of technique depends on various factors, including the woman's medical history and the specific cervical condition. The most common types include:
1. McDonald's cerclage: This is the most frequently used technique. A purse-string suture is placed around the cervix, and the ends of the suture are then tied together to provide support.
2. Shirodkar cerclage: In this technique, a tape or synthetic tape (like a Mersilene tape) is used to encircle the cervix, and it is then sutured in place to hold the cervix closed.
3. Transabdominal cerclage (TAC): This is a more invasive procedure where the cerclage is placed on the cervix via an abdominal incision. TAC is typically considered in cases where transvaginal cerclage is not feasible or has failed.
Causes for Cervix to be weak
- Had a cervical cerclage in an earlier pregnancy
- Having a short cervix
- A history of pregnancy loss in the second trimester
- Abortions in the past
Ideally, it is done between the 12th and 14th week of pregnancy. If done at this time it is known as emergent cerclage. It can be done any time before 24 weeks and is rarely done in the later stages unless found necessary. The stitch is removed around 36-37 weeks.
Cervical cerclage procedure
Before the procedure, an ultrasound will be taken to make sure the baby is fine and healthy. The doctor will also suggest tests to check for any infections. If found, a round of antibiotics must be taken and completed before the procedure.
During the procedure, local anesthesia is given to numb the pain. Surgery is usually done through the vagina. In some cases, when a vaginal cervical stitch has not worked or if it is not possible to do via the vagina, transabdominal cerclage is done. Progesterone shots may also be provided for additional help.
After the procedure, you may find vaginal bleeding for two days. You will have to visit your doctor every two weeks to make sure everything is fine. If the same procedure was followed in an earlier pregnancy, then you may need to stay in the hospital for some time.
Before delivery, the stitches will be removed. It is usually around 37 weeks or when you go into labor. If the stitches were done through a cut in the belly then the doctor will suggest a cesarean between 37 and 39 weeks.
There are a few risks associated with cervical cerclage such as vaginal bleeding, tear in the cervix, or infection. A cervical stitch will help to reduce the chances of having a miscarriage or premature birth, but it doesn’t mean we should not be careful. If you find anything different from usual, make sure to consult with your doctor.
