Cervical Cerclage to Prevent Preterm Delivery

Surgery Overview

Cervical cerclage is the placement of stitches in the cervix to hold it closed. In select cases, this procedure is used to keep a weak cervix (incompetent cervix) from opening early. When a cervix opens early, it may cause preterm labor and delivery. If you have an incompetent cervix, your doctor may recommend cervical cerclage.

Cervical cerclage involves stitching shut the cervix, which is the outlet of the uterus. Cerclage can be done preventively at 12 to 14 weeks before the cervix thins out, or as an emergency measure after the cervix has thinned. It is rarely used after 24 weeks.

Cerclage is performed using either general anesthesia or regional anesthesia (such as spinal injection). Usually cerclage is done through the vagina. A speculum, an instrument with paddles shaped like spoons, is inserted into the pregnant woman's vagina to spread the vaginal walls apart for the surgery. The surgery can be done in different ways:

• Stitches can be placed around the outside of the cervix.
• A special tape can be tied around the cervix and stitched in place.
• A small incision can be made in the cervix. A special tape is then tied through the cervix to close it.

If an incompetent cervix is diagnosed later in pregnancy, the woman's amniotic sac may begin to protrude through her cervix. This may be treated by inserting a thin tube (catheter) through the cervix, then inflating a bulb at the end of the catheter. Another technique involves filling the bladder with liquid using a catheter inserted through the urethra. The full bladder helps to push the amniotic sac back up into the pelvis, and the cervix can then be stitched shut.