Before pregnancy, the cervix is closed and rigid. During pregnancy, the cervix gradually softens, decreases in length (effaces) and opens (dilates) in preparation for birth. If you have an incompetent or weak cervix, however, your cervix might begin to open too soon. As a result, you could give birth prematurely.
Your health care provider might recommend cervical cerclage during pregnancy to prevent premature birth if you have:
- A history of three second-trimester miscarriages or premature births or two second-trimester miscarriages with no other identifiable causes
- A short cervix — as shown by ultrasound before week 24 of pregnancy — particularly if you've had a cervical injury, a history of premature birth or multiple miscarriages during your second trimester, or the length of your cervix is rapidly decreasing despite treatment with preventive medications
- Cervical dilation with a visible amniotic sac before week 24 of pregnancy (emergency or rescue cerclage)
If you experience recurrent pregnancy losses despite treatment with preventive medications or cervical cerclage, your health care provider might recommend cervical cerclage before conception. It's possible, however, that the cerclage might reduce your fertility.
Cervical cerclage isn't appropriate for everyone at risk of premature birth. Your health care provider might discourage cervical cerclage if you have:
Feb. 18, 2012
- Vaginal bleeding
- Preterm labor
- An intrauterine infection
- Premature rupture of membranes — when the fluid-filled membrane that surrounds and cushions the baby during pregnancy (amniotic sac) leaks or breaks before labor begins
- Prolapsed fetal membranes — a condition in which the amniotic sac protrudes through the opening of the cervix
- A multiple pregnancy
- A significant risk of miscarriage due to a severe fetal abnormality
- 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.