What is Cervical Cerclage?

Cervical cerclage is one of the methods applied to extend the pregnancy of expectant mothers at risk of premature birth before the 37th week of pregnancy. By prolonging the pregnancy, the baby can remain in the mother’s womb for a longer time, allowing for further development. This procedure can be performed either vaginally (transvaginally) or abdominally (transabdominally) through open surgery or laparoscopy, depending on the individual’s condition. Successful results are achieved in approximately 90% of the individuals undergoing this procedure. If there has been a history of miscarriage due to this condition in previous pregnancies, it is recommended to consult with specialists in the field before planning the pregnancy.

What is Cervical Cerclage?

Cervical cerclage is a surgical procedure performed to keep the cervix closed in order to prevent the risk of premature birth due to cervical insufficiency (weakness). During this procedure, your doctor will place a few stitches in the dilated cervix to keep it closed. For this reason, it is also known as cervical stitching. This procedure allows the baby to spend more time in the womb, completing its development.

Who is Cervical Cerclage Applied To?

During pregnancy, the cervix (the part of the uterus that connects to the vagina) dilates when the baby is ready for birth. In some individuals, the cervix may dilate very early or even before pregnancy due to cervical insufficiency (weakness). Since this condition can lead to premature birth, certain precautions need to be taken. One of these precautions is cervical cerclage. The following individuals may be candidates for cervical cerclage:

• Individuals whose cervix has dilated due to procedures such as LEEP (a procedure performed on the cervix) or surgeries on the cervix.
• Individuals who have experienced miscarriages due to having an abnormally shaped cervix.
• Individuals with cervical damage.
• Individuals who have a history of cervical cerclage in previous pregnancies.
• Individuals who have given birth before the 34th week in previous pregnancies.
• Individuals who have had miscarriages due to cervical dilation in previous pregnancies.

If you have the complaints mentioned above, it is recommended to consult a doctor as soon as possible. If, after examination, the doctor deems cervical cerclage appropriate, it is suggested to perform the procedure between the 12th and 14th weeks of pregnancy. Otherwise, as the pregnancy progresses, the cervix will thin out, making the procedure impossible

What Should Be Done Before the Cervical Cerclage Procedure?

Cervical cerclage is a surgical procedure applied to the cervix. Therefore, there are important points to consider before the procedure. These points are as follows:

• A medical examination by the doctor must be conducted to evaluate the patient's health history before the procedure.
• The doctor should be informed about the pregnancy, uterine surgeries, and procedures. Any complications related to these surgical procedures should be assessed.
• In case of infection, cervical mucus or samples of amniotic fluid can be collected from the patient for examination. Amniotic fluid is collected by inserting a needle into the abdominal area.
• Before the cervical cerclage procedure, a speculum (a metal device used to widen the vagina) should be placed in the vagina to examine the cervix.
• A vaginal ultrasound examination is necessary.
• The doctor may request that sexual intercourse be avoided starting one week before the procedure.
• Any questions the patient may have should be answered before the procedure. The patient should be comfortable and at ease during the procedure.

How is Cervical Cerclage Performed?

During the cervical cerclage procedure, the patient lies on the examination table with legs open and feet in stirrups. Local or epidural anesthesia is applied to the patient to prevent any pain before the procedure. To completely alleviate any pain that may occur during the procedure, the patient is given the necessary pain relief. While administering local anesthesia, there may be a slight squeezing and pain sensation in the cervix, but this feeling will pass shortly. After the anesthesia takes effect, the doctor will tightly stitch the cervix using the necessary surgical instruments to address the weakness in the cervix.

Will There Be Pain After Cervical Cerclage?

After the procedure, mild bleeding, cramping, pain, and spotting may occur for a few days. The pain experienced after the procedure should not last longer than a menstrual period. Pain relievers recommended by the doctor can be used for any discomfort.

Until healing occurs after the procedure, there may be a burning sensation while urinating. The intensity of these pain sensations can vary from person to person.

If bleeding, pain, cramping, or spotting occurs intensely and for an extended period, it is essential to inform the doctor.

When Should Cervical Cerclage Stitches Be Removed?

It is recommended that the stitches placed in the vagina during cervical cerclage remain until the 37th week of pregnancy. When it is time to remove the cerclage, many of the procedural steps are repeated.

As during the procedure, the patient lies on the examination table with legs open and feet in stirrups. The doctor will remove the stitches from the cervix. It is important not to move while the stitches are being removed.

If the water breaks or if labor needs to be initiated before the scheduled time for cerclage removal, the cerclage may be removed earlier.

What Are the Risk Factors of Cervical Cerclage?

The cervical cerclage procedure varies from person to person. The advantages of the procedure are weighed against the risks based on the patient's condition; if the advantages outweigh the risks, cervical cerclage is recommended. Like nearly every medical procedure, this one also carries certain risks. The risks to be aware of are as follows:

• Infection
• Damage to the cervix
• Bleeding
• Slippage of the stitches
• Early rupture of the membrane (the sac containing the baby in the womb)
• Early birth in case of membrane rupture

If early birth occurs, risk factors such as cervical laceration or uterine rupture may be observed due to the stitches not having healed yet.

What Should Be Considered After Cervical Cerclage Procedure?

After the procedure, the patient is monitored in the hospital for a few hours due to the risk of any complications. If no complications are observed, the patient can go home the same day.

To prevent infection risk, the doctor may prescribe appropriate antibiotic treatment. It is recommended that the patient takes the prescribed antibiotic at the scheduled times without delay.

To ensure the stitches heal properly after the procedure, it is advised to rest. Based on the doctor's recommendations, sexual intercourse, sports, and lifting heavy objects should be avoided for about 10 days. Patients can resume daily activities such as school or work the day after the procedure.

If high fever, foul odor from the vagina, regular contractions, lower abdominal pain, or excessive bleeding occurs after the procedure, the patient should immediately consult the performing physician.

It is important not to miss medical appointments to monitor the pregnancy and cervical cerclage.

Frequently Asked Questions

Cervical insufficiency is a common condition in our country, leading to frequent cervical cerclage procedures. To address any questions and concerns potential patients may have, here are some frequently asked questions regarding the procedure:

How Much Can Pregnancy Be Prolonged With Cervical Cerclage?
The primary purpose of this procedure, as known, is to prevent premature birth and extend the duration of pregnancy. The duration of pregnancy can be extended by an average of up to 5 weeks. This extension period varies from person to person. If labor begins before the 5-week mark, cervical cerclage may be removed earlier.

What Is the Follow-Up Process After Cervical Cerclage?
Patients should be monitored during and after the cervical cerclage procedure. In addition to the medications prescribed by the physician, regular ultrasound scans should be performed for follow-up. To prevent any complications (conditions that negatively affect the course of the disease), it is essential to attend regular hospital check-ups at the intervals recommended by the physician.