Cervical Cerclage

What is cervical cerclage?
It is a treatment for insufficient and incompetent cervix.

It is a surgical procedure to the cervix using tape, sutures or wires.

The procedure is done when:
1. History of:
Early premature labor.
Or
Mid pregnancy miscarriage before week 28.
2. The cervix is short or dilating too soon, detected during pregnancy follow-up visit.

Causes:
a. Birth defect.
b. Previous surgery on the cervix.
c. Trauma to the cervix from a previous miscarriage.
d. Cervical tear during a previous delivery.

Cervical cerclage contraindications:
1. Uterine contractions
2. Unexplained vaginal bleeding
3. Uterus or vaginal infection
4. Rupture of fetal membranes
5.Intrauterine fetal demise
6. Major fetal anomaly
7. Gestational age beyond 28 weeks

Timing of cervical cerclage placement:
Generally, the procedure is not done before week 12 and after week 28 of pregnancy.

Preparations for the procedure:
Ultrasound for fetal evaluation.

After the procedure:
1. The patient will experience some bleeding and cramps for few days.
2. Fetal and amniotic fluid volume screening before discharge from hospital.
3. It is advised to avoid intercourse for at least one week.
4. Ultrasound assessment every 2 weeks for cervical checks.
5. The cerclage is removed at week 37 then wait for labor which usually happens within 2 weeks, or if the mother has preterm birth.
6. The patient should go to the emergency if she experienced liquid leakage from the vagina because the cerclage might be removed if the fetal membranes was ruptured.

Progesterone supplementation might be used as part of delaying preterm labor.

Data are insufficient to support or condemn the use of Tocolytic therapy with cervical cerclage.

1 or 2 doses of Indomethacin might be given at the time of placement.

There are lack of sufficient data to either refuse or support the use of antibiotics at the time of cerclage placement.