Cervical cerclage insertion is a procedure where a non-absorbable suture material is use to reinforce the cervix (tying the mouth of the womb) to enable it retain pregnancy to maturity, which is considered to be 37weeks of pregnancy. This is mostly done in pregnant women who have been diagnosed with cervical insufficiency. It is often done as an elective procedure but can also be done as an emergency. It is usually done via the vaginal route but in selected patient it is done via the abdominal route. The transabdominal placement of a cervical cerclage could be via open surgery or laparoscopic surgery. The abdominal cerclage when inserted is usually left for subsequent pregnancies and delivery is via caesarean section. The vaginal cerclage is remove at 37weeks of pregnancy and delivery is via the vaginal route except vaginal delivery is contraindicated. Patient for cervical cerclage insertion are usually admitted a day prior to the procedure. The procedure is done in the theatre under anaesthesia, the patient might be awake or put to sleep. The suture material used include; mersilene tape, nylon, polypropylene and silk. The duration of stay in the hospital after the procedure is not fix it depend, it might take between 3days to more than a week.
WHO QUALIFIES TO GET A CERVICAL CERCLAGE INSERTED?
The following are the possible indications for cervical cerclage insertion;
- Pregnant women with previous history of pregnancy loss in the second trimester
- Women who have been diagnosed with cervical incompetence
- Pregnant women with incidental finding of cervical funnelling, shorten cervix <2.5cm on ultrasound
- Women with recurrent preterm delivery; delivery before 37weeks
- Women with more than one baby conceived via in-vitro fertilization (IVF), most specialist offer prophylactic cervical cerclage; which is preventive in women with no indication.
CONTRA-INDICATIONS TO CERVICAL CERCLAGE INSERTION
Cervical cerclage is not inserted or it is removed when inserted in the following situation;
- When the patient is contracting
- When the patient is bleeding
- If the fetus is not alive in the womb
- If the patient is draining liquor; the fluid that is enclosed in the sac containing the baby
WHEN IS CERVICAL CERCLAGE INSERTION DONE?
Cervical cerclage is inserted early in the second trimester as an elective procedure when there are no features of cervical changes on scan between 14 to 16weeks of pregnancy. This is to ensure that the pregnancy been locked in by the cerclage is viable and not destined genetically to abort due to genetic or structural malformation. However, other specialist will prefer to insert it earlier between 12 to 14weeks of pregnancy. Also, cervical cerclage insertion can be done as an emergency procedure in a woman with suspected cervical insufficiency on follow up ultrasound scan. This is known as a rescue cerclage because it is done when there are radiologically confirmed cervical changes on ultrasound scan.
PREPARATION DONE BEFORE THE PROCEDURE
Before the patient is admitted for the procedure, some investigations are done to assess the patient’s fitness for surgery. Ultrasound scan is also done to ensure that the fetus is alive, healthy and there is no drainage of liquor. The vaginal and cervix is also inspected and sample taken for test when indicated and any infection treated before the procedure. Some prenatal test might have been done in the first trimester to ensure the fetus is not genetically or structurally malformed. The anaesthetist will also be invited to see the patient to assess her fitness for anaesthesia and offer explanation on the options of anaesthesia available.
WHAT ARE THE COMPLICATIONS OF CERVICAL CERCLAGE INSERTION?
The following are the possible complications of cervical cerclage insertion;
- Membrane rupture
- Preterm labour
- Displacement of suture
- Formation of fistula; abnormal communication between the vagina and the urinary bladder or rectum.
- Cervical dystocia; due to scarring the cervix become unyielding during labour
- Cervical stenosis; the opening of the cervix becomes narrower
WHAT YOU SHOULD KNOW AFTER CERVICAL CERCLAGE INSERTION
After the insertion of the cerclage, you will remain on admission until your doctor is sure there is no problem. This is usually about 72 to 120hour for most prophylactic cerclage inserted. While on admission, notify your doctor if you feel abdominal pain, having vaginal bleeding or leaking water via the vaginal. There might be an increase in vaginal discharge which might be notice some weeks after discharge from the hospital. This might likely be due to the presence of a foreign material (the cerclage) in the vaginal however, it is important to notify your doctor about it. There are some situations in which the cerclage might be remove even if it was just inserted. These includes; when the baby’s water breaks, when you start having vaginal bleeding, when you are having labour pains and when the pregnancy has reach 37weeks.