What you can expectBy Mayo Clinic staff
Cervical cerclage is typically done as an outpatient procedure at a hospital or surgery center under regional or general anesthesia. Most cervical cerclage procedures are done through the vagina. Cervical cerclage might be done through the abdomen if transvaginal cerclage is unsuccessful or anatomically difficult due to an extremely short, lacerated or scarred cervix.
During the procedure
During transvaginal cervical cerclage, your health care provider will insert a speculum into your vagina and grasp your cervix with ring forceps. He or she might use ultrasound for guidance during the procedure. Your health care provider will likely use a technique known as the McDonald cerclage or the Shirodkar cerclage. Research suggests no significant difference in outcomes between the two methods.
To place the McDonald cerclage, your health care provider will likely use a needle to place stitches around the outside of your cervix. Next, he or she will tightly tie the ends of the sutures to close your cervix.
In the Shirodkar method, your health care provider will use ring forceps to pull your cervix toward him or her while pulling back the side walls of your vagina. Next, he or she will make small incisions in your cervix where your cervix meets your vaginal tissue. Then, he or she will pass a needle with tape through the incisions and tightly tie your cervix closed. After this method, your health care provider might use fine sutures to reposition vaginal tissue affected by the incisions. If a single cerclage doesn't provide enough closure, your health care provider might place a second cerclage around your cervix.
During transabdominal cervical cerclage, your health care provider will make an incision in your abdomen. He or she might gently elevate your uterus to gain better access to your cervix. Next, your health care provider will use a needle to place tape around the narrow passage connecting the lower part of your uterus to your cervix and tightly tie your cervix closed. Then he or she will settle your uterus back into place and close the incision.
After the procedure
After cervical cerclage, your health care provider will likely do an ultrasound to check your baby's well-being. If you had a transabdominal cervical cerclage, he or she will likely check to make sure blood flow through the uterus wasn't affected by the procedure and that the amniotic sac is positioned above the cerclage. You might experience spotting, cramps and painful urination for a few days. Acetaminophen is recommended for pain or discomfort. If your health care provider used fine sutures to reposition vaginal tissue affected by incisions in your cervix, you might notice passage of the suture material in two to three weeks as the stitches dissolve.
If you had cervical cerclage based on your past history of miscarriages or premature births, you'll be able to go home after you recover from the anesthetic. As a precaution, your health care provider might recommend remaining on bed rest for two days and avoiding sex for at least one week and, afterward, using condoms during sex.
If you had cervical cerclage because your cervix had already begun to open or an ultrasound showed that your cervix is short, your health care provider might prescribe antibiotics to reduce the risk of infection. As a precaution, your health care provider might recommend limiting physical activity and sex until the end of your pregnancy — generally week 32 through week 34 of pregnancy. Your health care provider might also recommend bed rest, although it isn't a proven remedy for preventing premature birth.
Your health care provider might recommend weekly or biweekly visits to examine your cervix until you give birth.
Cervical cerclage removal
A transvaginal cervical cerclage is typically removed during week 37 of pregnancy — when a baby is considered full term — or earlier if you begin premature labor. A McDonald cerclage can usually be removed in a health care provider's office without anesthetic, while a Shirodkar cerclage might need to be removed in a hospital or surgery center. After having a transvaginal cervical cerclage removed at term, you'll typically be able to resume your usual activities as you wait for labor to begin naturally.
If you expect to have a C-section and plan to have children in the future, you might choose to leave a Shirodkar cervical cerclage in place throughout your pregnancy and after the baby is born. However, it's possible that the cerclage could affect your future fertility. Be sure to consult your health care provider about your options.
If you had a transabdominal cervical cerclage, you'll need to have another abdominal incision to remove the cerclage. As a result, a C-section is typically recommended during week 39 of pregnancy. Your baby will be delivered through an incision made above the cerclage. During the C-section, you can choose to have the cerclage removed or leave it in place for future pregnancies. Keep in mind that a cerclage could affect your future fertility.
- Johnson JR, et al. Cervical insufficiency. http://www.uptodate.com/index. Accessed Oct. 4, 2011.
- Norwitz ER. Transabdominal cervical cerclage. http://www.uptodate.com/index. Accessed Oct. 4, 2011.
- Norwitz ER. Transvaginal cervical cerclage. http://www.uptodate.com/index. Accessed Oct. 4, 2011.
- Norwitz ER. Prevention of spontaneous preterm birth. http://www.uptodate.com/index. Accessed Sept. 22, 2011.
- Mancuso MS, et al. Prevention of preterm birth based on a short cervix: Cerclage. Seminars in Perinatology. 2009;33:325.
- Fox NS, et al. Cervical cerclage: A review of the evidence. Obstetrical and Gynecological Survey. 2008;63:58.
- Debbs RH, et al. Contemporary use of cerclage in pregnancy. Clinical Obstetrics and Gynecology. 2009;52:597.
- Daskalakis GJ. Prematurity prevention: The role of cerclage. Current Opinion in Obstetrics and Gynecology. 2009;21:148.
- Cunningham FG, et al. Williams Obstetrics. 23rd ed. New York, N.Y.: The McGraw-Hill Companies; 2010. http://www.accessmedicine.com/content.aspx?aID=6035539. Accessed Oct. 20, 2011.
- Rodgers VL, et al. Obstetrics and obstetric disorders. In: McPhee SJ, et al. Current Medical Diagnosis & Treatment 2012. 51st ed. New York, N.Y.: The McGraw-Hill Companies; 2012. http://www.accessmedicine.com/content.aspx?aID=9353. Accessed Oct. 20, 2011.
- Haas DM. Preterm birth. Clinical Evidence. 2011;4:1404.
- Groom KM, et al. Preconception transabdominal cervicoisthmic cerclage. American Journal of Obstetrics and Gynecology. 2004;191:230.
- Ludmir J, et al. Cervical incompetence. In: Gabbe SG, et al. Obstetrics: Normal and Problem Pregnancies. 5th ed. Philadelphia, Pa.: Churchill Livingstone Elsevier; 2007. http://www.mdconsult.com/books/page.do?eid=4-u1.0-B978-0-443-06930-7..50027-X&isbn=978-0-443-06930-7&uniqId=301267705-3. Accessed Nov. 14, 2011.