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. Your health care provider will likely use 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 use a needle to put stitches around the outside of your cervix. Next, he or she will 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 it meets your vaginal tissue. Then, he or she will pass a needle with tape through the incisions and tie your cervix closed. Your health care provider might use stitches to reposition vaginal tissue affected by the incisions.
During transabdominal cervical cerclage, your health care provider will make an abdominal incision. He or she might 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 tie your cervix closed. Then he or she will set your uterus back into place and close the incision. The procedure also can be done laparoscopically.
After the procedure
After cervical cerclage, your health care provider will do an ultrasound to check your baby's well-being.
You might experience some spotting, cramps and painful urination for a few days. Acetaminophen (Tylenol, others) is recommended for pain or discomfort. If your health care provider used stitches to reposition vaginal tissue affected by incisions in your cervix, you might notice passage of the material in two to three weeks as the stitches dissolve.
If you had history-indicated cervical cerclage, you'll likely be able to go home after you recover from the anesthetic. As a precaution, your health care provider might recommend 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, you might need to remain in the hospital for observation. As a precaution, your health care provider might recommend limiting physical activity and sex until up to week 34 of pregnancy.
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 at around week 37 of pregnancy — or at the onset of preterm 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, 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. 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 37 through 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.
March 17, 2015
- Berhella V, et al. Cervical insufficiency. http://www.uptodate.com/home. Accessed Jan. 20, 2015.
- Norwitz ER. Transabdominal cervical cerclage. http://www.uptodate.com/home. Accessed Jan. 20, 2015.
- Norwitz ER. Transvaginal cervical cerclage. http://www.uptodate.com/home. Accessed Jan. 20, 2015.
- Laughlin-Tommaso S (expert opinion). Mayo Clinic, Rochester, Minn. Feb. 5, 2015.
- Gabbe SG, et al. Obstetrics: Normal and Problem Pregnancies. 6th ed. Philadelphia, Pa.: Churchill Livingstone Elsevier; 2012. http://www.clinicalkey.com. Accessed Jan. 20, 2015.
- Alfirevic Z, et al. Cervical stitch (cerclage) for preventing preterm birth in singleton pregnancy. Cochrane Database of Systematic Reviews. http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD008991.pub2/abstract. Accessed Jan. 20, 2015.
- Rafael TJ, et al. Cervical stitch (cerclage) for preventing preterm birth in multiple pregnancy. Cochrane Database of Systematic Reviews. http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD009166.pub2/abstract. Accessed Jan. 20, 2015.
- American College of Obstetricians and Gynecologists (ACOG) Committee on Practice Bulletins — Obstetrics. ACOG Practice Bulletin No.142: Cerclage for the management of cervical insufficiency. American College of Obstetricians and Gynecologists. Obstetrics and Gynecology. 2014;123:372.