Cervical Cerclage: Types, Procedures, Precautions, and Risks

For expectant mothers at risk of preterm birth, medical procedures that help sustain pregnancy until full term are essential. Cervical cerclage is one of the most effective treatments for preventing early labor in women with cervical insufficiency (a weak cervix). This detailed guide covers all aspects of cervical cerclage, including its procedures, indications, recovery tips, and potential risks, with expert insights from Dr. Mustafa Aldam, Obstetrics and Gynecology doctor in Dubai. It explains when this treatment is necessary, what happens during the surgery, and how to take care of yourself afterwards.

What is Cervical Cerclage?

Cervical cerclage is a surgical procedure where stitches or synthetic tape are placed around the cervix during pregnancy. This intervention helps strengthen the cervix, preventing premature opening and reducing the risk of preterm birth.

There are two primary types of cervical cerclage:

• Transvaginal Cerclage – The most commonly performed method, where stitches are placed through the vagina.
• Transabdominal Cerclage – This involves making an incision in the abdomen to access the cervix, performed either through open surgery or laparoscopy.

The stitches offer extra support by keeping the cervix securely closed throughout pregnancy. This reinforcement is especially important for women with cervical insufficiency, where the cervix begins to open too soon without contractions, often leading to second-trimester pregnancy loss.

Doctors usually perform cervical cerclage between 12 and 14 weeks of pregnancy before the cervix starts thinning. This timing ensures optimal support during the critical stages of pregnancy.

Why is Cervical Cerclage Performed?

There are three main reasons why doctors recommend cervical cerclage:

• History-Indicated (Preventive) Cerclage – Suggested for women who have had one or more second-trimester pregnancy losses due to painless cervical dilation without labor or placental issues.
• Ultrasound-Indicated Cerclage – Advised when the cervix measures less than 25mm before 24 weeks of pregnancy in women with previous miscarriages or preterm births.
• Physical Examination-Indicated (Emergency) Cerclage – Performed when the cervix is already dilating before 24 weeks, provided there are no contractions or infections.

Previous cervical surgeries like LEEP procedures or other treatments that affect cervical tissue can weaken the cervix, making cerclage necessary. Additionally, women who have experienced miscarriages due to uterine abnormalities or cervical damage may benefit from this procedure.

Procedure Details

Before the Procedure:

Preparation for cervical cerclage in Dubai includes a thorough medical evaluation by the doctor. The gynecologist reviews the patient’s history, conducts a cervical examination, and performs a transvaginal ultrasound to assess cervical health.

During the Procedure:

The patient is positioned similarly to a routine gynecological exam. Appropriate anesthesia is administered to ensure a pain-free experience. The surgeon then places strong stitches around the cervix to keep it closed and secure, reducing the risk of early dilation.

Recovery and Aftercare:

After the procedure, patients remain under observation for a few hours to check for any immediate complications. Mild cramping and light bleeding may occur for up to three days. Important post-procedure care includes:

• Using sanitary pads instead of tampons
• Getting enough rest, preferably lying on the left side
• Staying hydrated and emptying the bladder regularly
• Avoiding strenuous activities for at least 2-3 days
• Refraining from sexual activity for about two weeks

Risks of Cervical Cerclage

While cervical cerclage is generally safe, some risks include:

• Infection or sepsis
• Cervical injury or scarring
• Bleeding
• Premature rupture of membranes
• Preterm labor
• Cervical stenosis (permanent narrowing of the cervix)
• Tearing if labor starts before the stitches are removed

When is Cervical Cerclage Removed?

The timing of cerclage removal is critical. Doctors typically take out the stitches between 36 and 37 weeks of pregnancy to avoid complications during labor.

However, in certain situations, early removal may be necessary, such as:

• Onset of labor
• Heavy vaginal bleeding
• Signs of infection (chorioamnionitis)
• Other medical conditions requiring immediate delivery

If a patient experiences preterm premature rupture of membranes (PPROM), doctors may delay cerclage removal until steroid treatments for fetal lung development are completed. For transabdominal cerclage, the stitches usually stay in place for a cesarean section and can even be retained for future pregnancies to prevent early births.

When to Consult a Doctor

Patients should contact their doctor immediately if they experience any of the following after the procedure:

• Fever above 100.5°F (37.8°C) or chills
• Regular contractions or persistent lower abdominal pain
• Heavy vaginal bleeding (soaking one sanitary pad in less than 3-4 hours)
• Foul-smelling vaginal discharge
• Water breaking or fluid leakage
• Continuous nausea and vomiting

Conclusion

Cervical cerclage is a crucial surgical procedure that helps many women carry their pregnancies to full term. Research supports its effectiveness, especially for women with cervical insufficiency or previous pregnancy losses. Although there are risks, careful medical supervision and following post-operative care guidelines significantly improve success rates for cervical cerclage.

Women who undergo cervical cerclage usually have positive outcomes, with many carrying their pregnancies close to term. Regular communication with doctor and prompt response to warning signs play a key role in achieving the best results with cervical cerclage in Dubai.