What to Expect After Cervical Cerclage?

A cervical cerclage procedure is needed when there are chances that your cervix may open quite earlier than the expected time of delivery.

In the non-pregnant stage, your cervix is normally closed and firm. After you become pregnant, the cervix goes on softening, and it opens (dilates) just before delivery. If your cervix is short or is weak enough to hold the baby, it dilates earlier (second trimester), resulting in premature delivery or miscarriage.

You may have a weak cervix due to

• History of late (second trimester) miscarriages.
• Procedures that involve the removal of tissue from the cervix (such as cone biopsy).
• Damage during an abortion.

Cervical cerclage can be done as early as 12 weeks until 23 weeks. Cervical cerclage is typically not done after week 24 of pregnancy due to the risk of early water breaking and subsequent premature birth.

The doctor will check a few things before planning cervical cerclage:

• Ultrasonography: This is done to check the baby’s heart rate and any major birth defects.
• Removing swabs of cervical secretions: This is sent to the laboratory to check if your cervix or uterus has any infection.

The doctor will administer either spinal anesthesia, regional (that covers the whole region of and near the cervix) anesthesia, or general anesthesia before the procedure. This helps you remain pain-free throughout the surgery.

There are two routes through which cervical cerclage can be performed. These are as follows:

1. Vaginal route: This is the most commonly used approach for performing cervical cerclage. This can be done as an outpatient procedure. This involves inserting an instrument through a speculum in your vagina and stitching the cervix with a band of thread. An ultrasound will be used to guide the doctor during the procedure.
2. Abdominal route: This approach is adopted if the vaginal route is unsuccessful or if your cervix has injuries. You will be usually admitted for a day or two for this type of surgery.

How do I know if my cerclage is successful?

To determine the success of a cerclage, you should consult with your healthcare provider, who will perform a cervical exam to check the cervix's length, consistency, and opening, as well as monitor your pregnancy using ultrasound scans and other methods to assess the health of your pregnancy. Other factors that indicate the success of a cerclage include carrying the pregnancy to term, or close to term, without any complications, such as preterm labor, or premature birth. If there are any concerns or signs of preterm labor, your healthcare provider will provide the appropriate care to help ensure the best outcome for you and your baby.

Complications with pre-planned cervical cerclage are uncommon and occur in less than 10 out of every 100 women. They are more often seen with emergency cervical cerclage. These include:

• Infection of the stitched area: As with any surgical procedure, there is a risk of infection at the surgical site.
• Premature contractions: The cerclage may not be effective in preventing preterm birth, and labor may still occur before 37 weeks.
• Premature rupture of the membranes (water breaking): It is possible if the patient continues to have contractions.
• Miscarriage or preterm delivery if the stitch fails
• Vaginal bleeding: Bleeding during or after the procedure can occur, although this is usually not severe.
• Cervical laceration (a tear in the cervix): This is possible with the vaginal route cervical cerclage procedure.

Each person recovers at a different pace. Depending upon the type of approach (vaginal/abdominal) and anesthesia type, your hospital stay can be anywhere between one and five days.

You need to avoid unnecessary physical activities for two to three days after the procedure or as advised by your doctor.

Sex is generally avoided until at least 32-34 weeks of pregnancy.

You are followed up at regular intervals (weekly or biweekly) to check the status of your cervix.

Repeat cerclage may be performed if the cervix opens again after the procedure. 

The doctor removes cervical stitches (cerclage) usually at 36-37 weeks of gestation.