Cerclage

What is cerclage?
Cerclage is the placement of a stitch around the opening of the cervix. This obstetrical procedure is used to prevent pregnancy loss in a woman who has an incompetent cervix. The stitch is made with non-absorbable material and is removed when the pregnancy is at full term to allow labor to begin.

What conditions is cerclage designed to treat?
Cerclage is designed to treat an incompetent cervix. Incompetent cervix is the inability of the cervix to remain closed, which results in premature delivery of the baby (miscarriage) without labor or contractions.

How cerclage performed?
Cerclage is performed under regional anesthesia (spinal or epidural). A needle is used to insert a band of material to hold the cervix closed. The stitch begins at the 6 o’clock position, going to 3 o’clock, from 3 o’clock to 12 o’clock, 12 o’clock to 9 o’clock, then back to 6 o’clock — creating a web over the opening of the cervix. Occasionally, antibiotics are administered. The stitch is usually placed at 13 to 14 weeks gestation and removed at 37 to 38 weeks gestation. Cerclage should not be performed after 24 weeks because of the increased risk of membrane rupture, premature labor, and infection. Bed rest is sometimes recommended as an additional precaution, but is generally not necessary.

What are the potential risks of cerclage?
Potential risks are infection resulting from stitches left in after premature rupture of membranes.

What are special instructions after the procedure?
The patient will be seen at least every 2 weeks until time to remove the stitch. If symptoms develop such as pelvic pressure, cramping, or spotting – weekly monitoring may be necessary. If the patient experiences premature rupturing of the membranes, the cerclage should be removed immediately.

Thomas G. Stovall, M.D.Dr. Stovall is a Clinical Professor of Obstetrics and Gynecology at the University of Tennessee Health Science Center in Memphis, Tennessee and Partner of Women’s Health Specialists, Inc.