A pregnant woman experiencing symptoms of Incompetent Cervix may require a cervical cerclage. A Cervical Cerclage is a band that is placed around the cervix, to prevent premature dilation, and loss of the baby. A cerclage is the routine treatment for Incompetent Cervix and is normally done after the 12th week of pregnancy. While having a Cervical Cerclage placement has its own risks the procedure is effective in preventing preterm labor and loss in 85%-90% of cases.
When a woman's cervix is weakened, by an underlying condition, it can have trouble supporting a pregnancy. A cervix that shortens, funnels, or dilates before full term falls into the category of Incompetent Cervix. A cervix that has been closed by cerclage will help the baby stay in the mother until it is time to be born.
A cervical cerclage may be considered if a woman is at risk for cervical insufficiency. This could be determined if the woman has had a previous second trimester loss, a cone biopsy, LEEP procedure; or a cervix that is damaged and weakened due to abortion or D&C. A woman is not a good candidate for a cervical cerclage when her water has broken or she has sufficient dilation. A cervical cerclage is most effective if placed between the 12th and 16th week. Some pregnant women may need a cerclage placed later in pregnancy known as an emergent cerclage.
A McDonald cerclage is the most common type of cerclage it's also known as the purse string stitch. The stitch is placed in a running in and out fashion, similar to the drawstring on a pruse, and then tied with a series of knots.The suture is placed into the upper part of the cervix when the bottom has started to efface. A doctor will try to place the stitch very high; as funneling of the cervix is a common symptom in Incompetent Cervix.
A Shirodkar cerclage is similar to a McDonald cerclage except that it passes through the walls of the cervix. The stitch is not exposed and it's thought to lessen the chances of infection. The Shriodkar cerclage is considered a more permanent solution to Incompetent Cervix and it is typically not removed. Women who have this type of cerclage will have a caesarean section (c-section) at the end of their pregnancy.
An abdominal cerclage is the least common type of cerclage in high risk pregnancies. This cerclage is permanent and used when the cervix is too short, or another type of vaginal cerclage has failed. The abdominal cerclage is usually placed during pregnancies, but, it can be used between pregnanices. This type of cerclage is not tight enough to prevent a D&C (dilation and curettage) if you miscarry. An abdominal cerclage comes with it's own risks and they should be considered carefully. This type of cerclage could result in severe complications and the loss of a woman's uterus.
A cerclage placement is as unique as your doctor and your pregnancy history. You may undergo general anesthesia, and a hospital stay, or an outpatient placement with a spinal block ,or epidural. Bed rest either at home or in the hospital is the normal course for recovery; until bleeding and cramping has stopped. Plan to relax during the 2-3 days following the procedure, at which time, light duty activity can be resumed in many cases.
The cervical cerclage will be left in until the doctor determines it must be taken out. 36 weeks gestation is the normal time to have the stitch removed, unless labor progresses before then. Having a cerclage placement can make dilation during labor hard, however doctors feel the risk of that is outweighed by the benefit of the procedure. Most women who have had a cerclage will require one in future pregnancies.
Having a cervical cerclage can be uncomfortable even after it has healed. Consider raising the foot of the bed a few inches off the ground to simulate the Trendelenburg position. The Trendelenburg position helps decrease the pressure on your cervix while you are laying in bed. Sleeping this way, during pregnancy, may provide relief for lower back pain and pelvic pain.
After having a cerclage you should not perform hard work. Lifting should be kept to a minimum, and no more than 10 pounds, in most cases. Repeated stooping or long hours on your feet is generally warned against. Some studies suggest that women who have a cerclage should refrain from intercourse. Your doctor will advise you on a medical plan and answer any questions or concerns you may have.
While many women come through the procedure with no complications there are signs to look for. A small amount of bleeding or cramping for a few days after placement is normal although, you may not experience these symptoms. Severe bleeding, contractions or fever are signs for concern. If you feel pressure on the stitch rest at home with your feet up as much as possible. If cramping is felt after you have healed decrease activity and call your doctor. You should not be able to feel the stitch after it has healed. If you notice that you can feel the stitch you should go see your doctor.
It is not uncommon for a woman who has had a cerclage to have pre-term contractions. While contractions during pregnancy are a cause for concern, in many cases, these contractions can be stopped with medication. When a woman who has a cerclage has contractions she needs to seek medical care. Contractions that change or dilate the cervix can cause bleeding and injury to the cervix. If you are unsure on the severity of your case it is always best to seek medical help.