Cervical cerclage, also called a cervical stitch, is implemented to treat cervical incompetence, or weakness. The cervix is the lowest part of the uterus that extends into the vagina. Cervical incompetence is a condition in which the cervix is slightly open. If left untreated, this condition can cause premature labor or miscarriage. A cervical cerclage essentially sews the cervix shut to ensure that the developing fetus remains inside the uterus until its intended delivery.
Types of Cervical Cerclage
A McDonald cerclage is the most common type of cervical cerclage. A McDonald cerclage is characterized by a purse-string stitch at the upper part of the cervix that cinches the cervix shut. This cervical cerclage is typically placed around 12 to 14 weeks of pregnancy. It is typically removed around 37 to 38 weeks when the fetus is developed and approaching delivery.
A Shirodkar cerclage is similar to a McDonald cerclage. In a Shirodkar cerclage, the sutures pass through the cervix walls. As a result, they are not exposed. Although this procedure is more difficult than a McDonald cerclage, it is believed to reduce the occurrence of infection. In some cases, a permanent stitch is placed around the cervix. This modification requires a cesarean delivery of the fetus.
An abdominal cerclage is the least common type of cervical cerclage. In an abdominal cerclage, the cervix is stitched at the top, which is inside the abdomen. This type of cervical cerclage is typically chosen when the mother’s uterus is too short for a standard cervical cerclage. It is also implemented after a vaginal cerclage is not possible or has previously failed. This method is believed to provide better outcomes than other types of cervical cerclage.
Implementation of Cervical Cerclage
Elective cervical cerclage has an 80% to 90% success rate if implemented properly. One of the most important factors is determining whether or not a cervix is truly incompetent. Cervical incompetence is defined as the dilation, or widening and effacing, or thinning, of the cervix before a pregnancy has reached its term. To determine this, the operating medical professional should perform an examination andtransvagial ultrasound.
Multiple pregnancies, previous cervical cerclage, uterine abnormalities, cervical length, and cervical trauma should be taken into consideration. Proper placement of a cervical cerclage is a main component of success. Also critical to success is the amount of tension in the cervical cerclage. Tension plays a key role in the prevention of infection and membrane prolapse.
Complications of Cervical Cerclage
Cervical cerclage involves risks and complications that can be potentially fatal to the mother and fetus. Due to the intricate nature of a cervical cerclage, it is imperative that the operating medical professional has sufficient training and experience. Furthermore, the patient should be monitored frequently after the placement of a cervical cerclage to prevent the onset of complications.
Complications of cervical cerclage include:
- Regional or general anesthesia risks
- Premature labor
- Premature membrane rupture
- Cervical infection
- Chorioamnionitis, or amniotic sac infection
- Cervical or bladder injury
- Cervical displacement
- Bleeding or hemorrhaging
- Cervical rupture if the stitch is not removed before labor
- Cervical dystocia, or dilation failure requiring cesarean section