Cervical cerclage is a surgical procedure used to prevent premature birth or miscarriage in women with an incompetent or weakened cervix, which may begin to open too early during pregnancy. There are different types of cervical cerclage, including transvaginal cerclage (TVC), which is the most common and involves stitching the cervix closed through the vagina; transabdominal cerclage (TAC), which is performed through an abdominal incision when a transvaginal approach is not viable; and emergency cerclage, done when the cervix has already started to open prematurely. The procedure is typically performed between 12 to 14 weeks of pregnancy, though an emergency cerclage can be done later if necessary. The process involves placing a strong suture around the cervix to reinforce it and prevent premature dilation. After the procedure, precautions such as avoiding heavy lifting, prolonged standing, sexual intercourse, and strenuous activities are recommended to reduce the risk of complications. Regular follow-up visits, including ultrasounds and cervical length monitoring, are essential to ensure the effectiveness of the cerclage. Despite its benefits, cervical cerclage carries potential risks, including infection, bleeding, premature rupture of membranes, uterine contractions, and, in rare cases, cervical injury or preterm labor. The sutures are typically removed around 36 to 37 weeks of pregnancy, or earlier if labor begins on its own. While cervical cerclage has a high success rate in preventing preterm birth in women with cervical insufficiency, the decision to undergo the procedure depends on individual medical history, and it is essential to discuss the risks and benefits with a healthcare provider.

Cervical cerclage is a surgical intervention used to support the cervix in pregnant women who have been diagnosed with cervical insufficiency, a condition in which the cervix begins to shorten and dilate too early, increasing the risk of second-trimester miscarriage or preterm birth. The procedure is typically recommended for women with a history of recurrent pregnancy loss due to cervical incompetence, those who have undergone cervical surgery in the past, or those identified through ultrasound screening as having a short cervix. There are three main types of cervical cerclage: McDonald cerclage, a simpler and more commonly performed vaginal cerclage in which a purse-string suture is placed around the cervix; Shirodkar cerclage, a variation where the suture is placed higher up near the internal os and may require the bladder to be moved slightly; and transabdominal cerclage (TAC), a more invasive option performed through an abdominal incision, typically for women with a history of failed vaginal cerclage or severely shortened cervix. The procedure is usually performed between 12 to 14 weeks of gestation under regional or general anesthesia and is done either as an outpatient or inpatient procedure, depending on individual circumstances. After the cerclage is placed, women are advised to rest, avoid heavy lifting, reduce physical strain, and refrain from sexual activity for a certain period to minimize strain on the cervix. While cervical cerclage is an effective preventive measure, it is not without risks, which include infection, cervical laceration, preterm labor, rupture of membranes, or, in rare cases, uterine rupture. The success rate of cervical cerclage varies but is generally high in women with properly diagnosed cervical insufficiency. The cerclage is typically removed around 36 to 37 weeks, though in some cases, earlier removal may be necessary if contractions, preterm labor, or other complications occur. Close monitoring through ultrasound and regular prenatal visits is essential to assess the condition of the cervix and ensure a healthy pregnancy outcome. While cervical cerclage has proven to be a lifesaving measure for many women at risk of preterm birth, its necessity and effectiveness depend on individual medical history, making thorough consultation with a healthcare provider crucial before undergoing the procedure.

Cervical cerclage is a crucial surgical procedure designed to reinforce a weak or incompetent cervix, helping to prolong pregnancy and reduce the risk of miscarriage or preterm birth. This procedure is most commonly recommended for women with a history of second-trimester losses due to painless cervical dilation, previous cervical surgeries that may have weakened the cervix, or those diagnosed with a short cervix via ultrasound. The timing of cervical cerclage plays a significant role in its effectiveness, with prophylactic cerclage typically performed between 12 and 14 weeks of pregnancy in women with a known history of cervical insufficiency. Rescue or emergency cerclage may be done later in pregnancy if the cervix is already dilating but membranes are still intact. There are three main types of cerclage procedures: McDonald cerclage, the most commonly used method, involves placing a strong suture around the cervix in a purse-string manner; Shirodkar cerclage, which is similar but involves securing the suture higher up and anchoring it more firmly, often requiring a small incision to reposition the bladder; and transabdominal cerclage (TAC), which is performed through an abdominal incision and is typically reserved for women with previous failed transvaginal cerclages or extremely short cervices. TAC is often placed before pregnancy or in the first trimester and requires a cesarean delivery for birth. The cerclage placement is usually performed under spinal, epidural, or general anesthesia and can be done as an outpatient procedure or with a short hospital stay.

After the cerclage is placed, women are advised to take necessary precautions, including avoiding heavy lifting, excessive physical activity, sexual intercourse, and prolonged standing, particularly in the weeks following the procedure. Some doctors may also recommend modified bed rest or pelvic rest, depending on individual circumstances. Regular monitoring through transvaginal ultrasounds and cervical length measurements is crucial to assess the integrity of the cerclage and the overall condition of the cervix throughout pregnancy. Despite its benefits, cervical cerclage carries potential risks, such as infection, vaginal bleeding, cervical tearing, preterm contractions, preterm premature rupture of membranes (PPROM), and, in rare cases, uterine rupture or miscarriage. Additionally, while the majority of cerclages are removed around 36 to 37 weeks, some may need to be removed earlier if preterm labor begins or if there are signs of infection or complications. Women with transabdominal cerclage will need a planned cesarean section, as the suture is not removed before delivery.

The effectiveness of cervical cerclage varies depending on factors such as the timing of the procedure, the severity of cervical incompetence, and the presence of additional risk factors like uterine anomalies or multiple gestations. Studies have shown that for women with a clear diagnosis of cervical insufficiency, cerclage can significantly improve pregnancy outcomes, reducing the chances of preterm birth and increasing the likelihood of carrying the baby to term. However, not all cases of short cervix or preterm labor benefit from cerclage, and it is not typically recommended for women with active infections, multiple gestations without a history of cervical insufficiency, or advanced cervical dilation with ruptured membranes. Alternative treatments, such as progesterone supplementation or cervical pessary, may be considered in certain situations where cerclage is not suitable.

Overall, cervical cerclage remains a widely used and effective intervention for preventing pregnancy loss and preterm birth in high-risk women. However, its success depends on careful patient selection, proper procedural technique, and diligent prenatal monitoring. Women considering or undergoing cerclage should maintain close communication with their healthcare provider to ensure optimal pregnancy management and promptly address any concerns or complications.