Cervical Cerclage

Introduction

When a woman's cervix is weak (sometimes known as incompetent cervix), she is more prone to have a child born prematurely because the cervix shortens or opens prematurely. To prevent too early labor, a woman's doctor may advise a cervical cerclage.

A cerclage is utilized to prevent these early alterations in a woman's cervix, thus preventing premature labor. A closed cervix aids a developing baby stay inside the womb until the mother reaches 37-38 weeks of pregnancy.

What is Cervical Cerclage?

The method of treatment for cervical incompetence is a surgical procedure referred to as cervical cerclage (or cerciage), in which cervix is sewn closed during pregnancy. The cervix is the lowest narrow end of the womb (uterus) and extends into the vagina.

Why is Cervical Cerclage Utilized?

A cervical cerclage procedure may be utilized if a woman's cervix is prone to opening under the pressure of the growing pregnancy.

When is Cervical Cerclage Utilized?

The best period for the cervical cerclage procedure is in the third month of pregnancy. However, few women may require a cerclage placed later in pregnancy; this is referred to as an emergent cerclage and is necessary post modifications like opening or shortening of the cervix have already commenced. If an emergency cerclage is needed, future pregnancies will probably also need a cervical cerclage.

Benefits of a Cervical Cerclage

Cervical cerclage aids prevent miscarriage or premature labor caused by cervical incompetence. The procedure is successful in approximately 85% to 90% of cases. Cervical cerclage happens to be effective when true cervical incompetence exists, but less fortunately, the diagnosis of cervical incompetence is very tough and can be imprecise.

Why Doesn't Every Woman Who Has Had a Preterm Baby Require a Cerclage?

In instances when women have an abnormal or "incompetent" cervix, she can be aided by a cerclage. However, even with the aid of a cerclage, other issues can cause labor to start too early. Women who have a cerclage placed will required to be checked regularly for other complications like infection as well as preterm labor.

What to Expect Before Cervical Cerclage is Placed?

• Woman's medical history will be reviewed.
• A thorough exam of her cervix comprising a transvaginal ultrasound conducted by a healthcare professional who specializes in high-risk pregnancies.
• Healthcare professionals will discuss pain control choices for the procedure.
• Woman can write down any queries or concerns to discuss with health care provider.

What Happens During the Cervical Cerclage Procedure?

Majority of women have general, spinal, or epidural anesthesia for pain control during the procedure. A healthcare professional will stitch a band of strong thread around the cervix portion, and the thread will be fastened to hold the cervix tightly closed.

What to Expect after the Cervical Cerclage Procedure?

Woman may remain in the hospital for some hours or overnight to be monitored for before time contractions or labor.

Immediately after the completion of procedure, she may experience light bleeding and mild cramping, which should halt after a few days. This may be followed by an increased thick discharge of the vagina, which may continue for the remainder of the pregnancy.

• Woman may get medicines to prevent infection or preterm labour.
• For 2-3 days post the procedure, plan to relax at home; avoid any unnecessary physical exertion.
• Healthcare professional will discuss with her when would be the suitable time to resume regular activities.
• Abstinence from sexual intercourse is usually advised for 7 days before and at least 7 days post the procedure.

How Long is the Cerclage Stitch Left in?

Usually, the thread is taken out at the 37th week of pregnancy, but it can be taken out before a woman's water breaks or contractions begin. The majority of stitches are removed in the doctor's office without any issues. The procedure is like having a pap smear and may cause some light bleeding.

What are the Risks of Having Cervical Cerclage Placed?

The probability of risks happening is very low, and the majority of healthcare professionals feel a cerclage is a life sustaining procedure that outweighs the possibility of risks involved.

Possible risks could comprise:

• Premature contractions
• Cervical dystocia (inability of the cervix to increase in diameter typically during labor)
• Rupture of membranes
• Infection of cervix
• Cervical laceration if labor happens prior to the cerclage is taken out.
• Some risks linked with general anesthesia comprising vomiting and nausea. 

Lifestyle Changes Post Cervical Cerclage Procedure

After undergoing a cervical cerclage procedure, healthcare provider may advise specific lifestyle alterations to make sure the best possible outcome for pregnancy and to decrease the chances of complications. Keep in mind that these suggestions can differ based on individual circumstances, so it's crucial to follow the advice provided by the healthcare team. Here are some general lifestyle alterations that may be suggested:

Rest and Activity Restrictions:

• Woman may be advised to limit strenuous physical activities and avoid heavy lifting during recovery period.
• Resting and avoiding overexertion can aid reduce the stress on cervix and bolster the process of healing.

Avoid Sexual Intercourse:

• Healthcare provider may suggest refraining from sexual intercourse for a certain period post the cerclage procedure. These aids reduce the infection chances and other complications.

Hydration and Nutrition:

• Stay hydrated by drinking enough water daily.
• Follow a balanced and nutritious diet to bolster overall health and the health of pregnancy.

Management of stress:

• Engage in stress-reduction techniques like relaxation exercises, meditation, deep breathing, as well as gentle yoga.
• High-stress levels can potentially impact pregnancy, so managing stress is crucial.

In a nutshell, cervical cerclage is a surgical procedure aimed at preventing premature labor in women with cervical incompetence. While not every woman who has had a preterm birth requires this procedure, it can significantly reduce the risk of miscarriage in those with an incompetent cervix. The procedure involves sewing the cervix closed temporarily, usually’ during the third trimester of pregnancy. Following cervical cerclage, lifestyle adjustments may be recommended to promote a healthy pregnancy. Ultimately, cervical cerclage can be an important intervention for women at risk of preterm labor, providing them with the opportunity to deliver a healthy baby.