Cervical Cerclage

What you should know

• A cervical cerclage, also called cervical stitch, is a surgery to keep the cervix closed during pregnancy. The cervix is the lowest part of the uterus (womb) and extends into the vagina. This surgery may help prevent a miscarriage or premature (early) delivery of your baby due to an incompetent cervix. An incompetent cervix is a condition where the cervix thins and dilates (widens) too early during the pregnancy. A cervical cerclage is usually done during pregnancy but may be done sometimes even before you get pregnant. An elective cerclage is usually carried out before the 16th week of pregnancy. It may be done to those with a past history of pregnancy loss or premature delivery. Depending on the symptoms, an urgent or emergency cerclage may be performed during the 16th to 24th week.
  
  
• A cervical cerclage may be done through a laparoscopic abdominal (stomach) or vaginal approach. In a laparoscopic abdominal cerclage, a laparoscope will be inserted in the small incisions (cuts) made in your abdomen. A laparoscope is a long metal tube with a light and magnifying glass on the end. In transvaginal cervical cerclage, your caregiver will do the surgery through your vagina. In both approaches, caregivers will pass strong sutures (threads) around your cervix to hold the cervix firmly closed. The sutures may be removed when labor starts, or around the 37th week of pregnancy. If the sutures are left in place, your baby will be delivered by a surgery called Caesarean (C) section. By doing a cervical cerclage, the cervix will remain closed as your baby grows and gets ready to be born.

Care Agreement

You have the right to help plan your care. Learn about your health condition and how it may be treated. Discuss treatment options with your caregivers to decide what care you want to receive. You always have the right to refuse treatment.

Risks

• Problems may happen during your cervical cerclage that may lead to a laparotomy (open surgery). Your intestines, womb, bladder, or bag of water may get injured while having the surgery. You could also have trouble breathing, an infection, or too much bleeding after surgery. Sometimes, the surgery may cause you to go into labor and the risk of having a miscarriage may also increase. Your cervix may tear open if the tie around the cervix is not removed while you are in labor. Even after a cervical cerclage, there reamins a chance that you will have problems during your pregnancy or delivery.
  
  
• Without treatment, you may have a miscarriage or premature delivery of your baby. Your cervix will remain weak and keep on widening or opening. Your baby and bag of water may push out of your vagina even if it is too early. This may lead to other serious medical problems for you and your baby. Ask your caregiver if you are worried or have questions about your surgery, medicine, or care.

Getting Ready

The week before your surgery:

• Ask a family member or friend to drive you home after your surgery. Do not drive yourself home.
  
  
• Ask your caregiver if you need to stop using any of your present medications. These may include aspirin, ibuprofen, or blood thinners.
  
  
• Ask your caregiver before using any over-the-counter or herbal medicine or supplement. If you regularly use these medicines or supplements, tell your caregiver.
  
  
• Keep a record of the number of times you feel your abdomen (stomach) contract each day. Bring this record with you when you see your caregiver.
  
  
• You may need to have urine test, ultrasound, chest x-ray, and blood tests. Ask your caregiver for more information about these and other tests that you may need. Write down the date, time, and location of each test.

The night before your surgery:

• Ask caregivers about directions for eating and drinking.
  
  
• Your bowel may need to be emptied and cleaned out before the surgery. Caregivers may give you a liquid medicine called an enema. This will be put into your rectum (rear end) to help empty your bowel. Your caregiver will teach you how to do this.
  
  
• You may be given a pill to help you sleep.

The day of your surgery:

• Write down the correct date, time, and location of your surgery.
  
  
• Ask your caregiver before taking any medicine on the day of your surgery. These medicines include insulin, diabetic pills, high blood pressure pills, or heart pills. Bring all the medicines you are taking, including the pill bottles, with you to the hospital.
  
  
• Do not wear contact lenses on the day of your surgery. You may wear glasses. Wear socks to help you stay warm.
  
  
• If you are staying in the hospital after your surgery, bring your personal belongings with you. These include your bathrobe, toothbrush, denture cup (if needed), hairbrush, and slippers.
  
  
• Caregivers will insert an intravenous tube (IV) into your vein. A vein in the arm is usually chosen. Through the IV tube, you may be given liquids and medicine.
  
  
• An anesthesiologist may talk to you before your surgery. This caregiver may give you medicine to make you sleepy during your surgery.
  
  
• You or a close family member will be asked to sign a legal piece of paper (consent form). It gives your caregiver permission to do the surgery. It also explains the problems that may happen, and your choices. Be sure all your questions have been answered before you sign this form.

Treatment

What will happen:

• You may be given medicine to help you relax or make you drowsy. You will be taken on a cart to the operating room and then moved into a special bed. Your abdomen and genital (vaginal) area will be cleaned with soap and water. Sheets will be put over you to keep the surgery area clean. A catheter may be inserted into your bladder to inject clean water through, and it is also used to drain your urine. Caregivers may give a spinal or general anesthesia to make you comfortable during surgery. Your legs will be put up in stirrups (leg holders).
  
  
• In a laparoscopic abdominal cerclage, small incisions are made in the lower abdomen. Caregivers will insert special tools and a laparoscope through these incisions to do the surgery. During this surgery, bands of tapes are used to wrap around the cervix and surrounding ligaments. These tapes will be sutured and tied to keep the cervix closed. The incisions are then closed by stitches or surgical tapes and covered with bandages.
  
  
• With transvaginal cervical cerclage, a speculum widens and holds open the vagina to show your cervix. Sometimes, an incision is made through the skin of your vagina. Sutures will be sewn and tightened around your cervix to hold the cervix firmly closed. The incision is then closed with stitches. A vaginal pack or sanitary pad is placed to cover your incision and control the bleeding.

After your surgery:

You may be taken to a recovery room until you are fully awake. You may need to lie flat and still in bed for a few hours. Do not get out of bed until your caregiver says it is OK. Your caregiver will decide when you will be taken back to your regular room. You may have a foley catheter in your bladder while you are still in the hospital. The bandage or vaginal pack used to cover your stitches keeps the area clean and dry to prevent infection. A caregiver may remove it soon after your procedure to check the sutures. Ask your caregiver for more information on catheter care and about ways to prevent bleeding.

Waiting area:

This is an area where your family and friends can wait until you are able to have visitors. Ask your visitors to provide a way to reach them if they leave the waiting area.

Contact a caregiver if

• You cannot make it to your appointment on time.
  
  
• You have questions or concerns about your surgery.
  
  
• You have a fever.

Seek Care Immediately if

• You feel something is bulging out into your vagina.
  
  
• You have clear fluid coming from your vagina.
  
  
• You have lower abdominal (stomach) or back pain that comes and goes like labor pains.
  
  
• You have regular contractions.
  
  
• You have vaginal bleeding.

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The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.