Cervical cerclage

Evidence 

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5041069/ 

Corrine Lu, Boon Lim and Stephen J. Robson 

Cervical cerclage has been the traditional management technique used to reduce the incidence of preterm birth in women suspected of or being shown to have a shortened cervix, commonly based on history and ultrasound examination in mid-trimester. 

Education 

What is a cervical suture? 

A cervical suture is where a suture (stitch) is placed around your cervix (the neck of your womb) during pregnancy. It is sometimes also called a cervical cerclage. It is usually done between 12 and 24 weeks into your pregnancy. 

Why is it done? 

A cervical suture can reduce the risk of having your baby early, or ‘preterm’. Preterm is when your baby is born between 20 and 37 weeks into your pregnancy. Babies born preterm have a higher risk of having short and long-term health problems. 

We don’t always know why a baby is born early but sometimes it can be because of changes in your cervix, where it becomes shorter (less than 25mm) and opens too early. A cervical suture can help to keep your cervix closed. This can help reduce the risk of your baby being born preterm. 

What is involved in the operation? 

You will be in an operating theatre and have anaesthetic when your cervical suture is put in. You may have a: 

• Spinal anaesthetic where you will stay awake but will be numb from the waist down

OR 

• General anaesthetic where you will be asleep

The anaesthetist will usually discuss the options with you. You should not eat or drink for 4-6 hours before the operation. 

In the operating theatre, your legs will be placed in supports and sterile covers be used covers to keep the operating area clean. 

Your doctor will put a speculum (an instrument used to separate the walls of your vagina to show your cervix) into your vagina and put the suture around your cervix.  

You may also have a tube (catheter) put into your bladder. This will be removed once the anaesthetic has worn off. The operation should take about 30 minutes. You may be given a suppository (medicine) in your bottom (back passage) to help prevent contractions before or after the procedure. 

Depending on where you live and your medical history, you may go home the same day or may be required to stay in hospital for one night after your suture is inserted. 

What should I expect afterwards? 

After the operation, you might have some light bleeding from your vagina. This should change to a brown colour after a day or two. You may also have some lower abdominal and vaginal pain.  

Due to the position of the stitch some pain and discomfort may continue after you go home from hospital. You may need to take over the counter pain relief medications, like paracetamol, once you are at home, following the dosage instructions on the packet. Resting in bed is not recommended. Light activity, for example walking, is best for you and your baby.  

Sexual intercourse is not recommended until your first medical review which usually happens two weeks after your operation. Your doctor will tell you more about what you can do and what you should avoid after your operation. 

Is there anything I should look out for? 

If you experience any of the following symptoms, you should contact the nearest birthing suite for advice.  

• contractions or cramping 

• heavy vaginal bleeding 

• your waters break 

• smelly vaginal discharge 

• fever. 

When will the suture be taken out? 

If you think you are in labour, contact the hospital straight away. If you go into labour with the cervical suture in place, it is very important to have it removed quickly to prevent damage to your cervix. 

Otherwise, the suture will normally be removed around 36-37 weeks into your pregnancy. 

Your suture will be taken out in the hospital. You will not normally need an anaesthetic for the removal. A speculum will be inserted into your vagina and the suture will be cut and removed. It usually takes a few minutes, and you may go home after that. Occasionally the suture will need to be removed in theatre using an anaesthetic. 

Your care plan will be discussed with you for the rest of your pregnancy. 

Empowerment 

For many women, pregnancy is a time of elation and excitement. The joy of discovering you’re pregnant and sharing the news with friends and loved ones is a special time. But for some women, the idea of pregnancy or the fear of miscarriage or pregnancy loss can overshadow the feelings of excitement. 

For women who have experienced the devastation of miscarriage, gone into labour early, or who might have been told they have a weak cervix, pregnancy can be a worrying time. 

If you’ve been diagnosed with cervical insufficiency or a weakened cervix, understanding your condition and knowing your options might help you to feel more in control during your pregnancy. 

Cervical cerclage serves as a beacon of hope for women facing cervical incompetence, offering a proactive solution that can potentially prevent preterm labour and miscarriage. By addressing the underlying issue, this procedure opens new avenues for successful pregnancies, empowering women to embrace motherhood with optimal outcomes. 

Useful Links 

Australian Journal of General Practice published by the Royal Australian College of General Practitioners 

https://www1.racgp.org.au/ajgp/2019/march/the-shortened-cervix-in-pregnancy 

The Australian Preterm Birth Prevention Alliance 

https://www.pretermalliance.com.au/Our-Research/Clinical-Guidelines 

Miracle Babies Foundation 

https://www.miraclebabies.org.au/content/cervical-incompetence/gm41js 

Belly Belly  

https://www.bellybelly.com.au/pregnancy/what-is-cervical-cerclage-all-you-need-to-know/ 

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