Introduction

Cervical Cerclage is a procedure performed to overcome the problem of a short cervix. If a short cervix is left untreated, it might cause bigger problems like premature delivery. With the help of this procedure, the uterus is provided with a support so that it doesn’t dilate and open too early during pregnancy. It is done because of ample of reasons, such as:

  • If you have a short cervix
  • If you have suffered through pregnancy loss in the past

In this procedure, the uterus is sutured so that it stays close and it is removed later when the time is right, i.e., when your baby is ready to be born. There are multiple ways in which the procedure can be performed; we will study about this in the later section. When a woman gives birth, the birth takes place in steps. These steps are:

Step 1: The length of the cervix decreases and it becomes soft. This process is also known as effacing.

Step 2: The next step is the step of dilation. The cervix gradually opens up.

Although the procedure is performed to support your uterus for avoiding premature delivery, there are certain risks involved with it. These risks are enlisted below:

  • Abnormal vaginal bleeding
  • Bacterial infection in the fetal membranes
  • Cervical laceration
  • Premature breaking of water

Cervical Cerclage is often not recommended by the doctor if you have any of the following medical conditions:

  • Abnormal vaginal bleeding
  • Uterine infection
  • Premature opening of cervix
  • If your water breaks too early

If you have any of the above medical conditions, it is not safe to go ahead with Cervical Cerclage.

The main agenda of performing a cervical Cerclage is to avoid miscarriage or premature delivery of the baby. If there is even the slightest possibility of preterm labour, your doctor will recommend Cervical Cerclage, especially if you have had a history of pregnancy loss because of short cervix.

Types

Broadly, the cerclage is classified into three categories, viz, McDonald cerclage, Shirodkar cerclage, abdominal cerclage.

McDonald cerclage

The procedure is named after its discoverer, i.e. McDonald. It is a  purse string stitch used to cinch the cervix close. A band of sutures is applied to the upper area of the cervix while the lower part has already begun to decrease in length.

It is preferred that the procedure is carried out in between the 16th and 18th week of pregnancy. It is appropriate to remove sutures around the 37 week or earlier.

Shirodkar cerclage

To some extent, Shirodkar cerclage resembles the McDonald cerclage. The name of the procedure is derived from its inventor’s name, i.e., V. N. Shirodkar. The main difference arises because while the doctor uses the Shirodkar Technique, he/she not only uses the needles but also attaches a band along to shut the cervix.

Abdominal cerclage

Abdominal cerclage is not often performed. In this procedure, permanent placing of a band is carried out. The band is placed over the cervix. It is named as abdominal cerclage because it is performed inside the abdomen via a small incision. It is the last option, when the regular cerclage fails or the cervix can’t be closed using the standard ones.

Research is still going on so that the regular vaginal cerclages can be replaced with the transabdominal cerclage (TAC) because they have shown better results in the past.

How is it done

The procedure is classified into three periods, i.e., pre-surgical measure, while the surgery takes place, post-surgical measures. We will discuss about all the three periods in detail.

Before getting into the particulars of the procedure, it is essential for you to be aware about certain precautions, or measures that you must take or do on your part in order for the surgery to go smoothly. These measures are:

  • You should have someone to assist you after the surgery to get you home as you might be a little drowsy and weak to go on your own.
  • You must inquire your doctor about your medications and should also inquire about other health issues if you have any.
  • Ask your doctor as many questions as you can.

Pre-surgical measures

Before the procedure, a few tests are carried out to get a clear picture of the baby’s as well as the mother’s health. These tests include:

  • Urine samples
  • Blood tests
  • Most importantly the ultrasound
  • Amniocentesis

As mentioned earlier, it is best to go ahead with the procedure in between 12 to 14th week of your pregnancy. In some cases, it might be extended until 23rd week, but after that it is extremely unsafe to perform the cerclage. The sutures are usually removed by 37th week or in some cases earlier.

A few hours or sometimes a night before the procedure, your cervix is allowed to dilate so that it opens up a little and the procedure can be carried out swiftly.

How is the surgery performed?

In this section, we will be discussing about the complete method of how the procedure is carried out. The process differs from method to method. We will discuss about all the types of cerclages.

  1. McDonald Operation

This method involves the use of needles. Needles are used to stitch the outer area of your cervix. After the stitching is done, the end of the suture is tied together to shut the cervix close.

  1. Shirodkar Operation

As mentioned earlier, Shirodkar method and McDonald method are somewhat similar. The Shirodkar method involves the use of ring forceps. The doctor inserts the ring forceps through your uterus and the cervix is pulled outward. This pulls back the walls of the vagina and provided room for the procedure. Then after a cut is made in the cervix. The last step is closing of the cervix by using needles and tape.

  1. Abdominal cervical cerclage

Abdominal cervical cerclage is often preferred when you still plan on having kids in the future. An incision is made in your abdomen. After this, your uterus is pulled up to get a clear picture of your cervix and a tape is placed over your cervix with the help of needles. This tape need not be removed even after surgery. After the band has been perfectly placed, further repositioning is done and the incision is closed.

  1. Transvaginal Cervical cerclage

In this method of cerclage, a special instrument called a speculum is inserted inside your vagina. After the vagina is wide open, the cervix is grabbed with the help of ring forceps.

Post-Surgical Measures

Ultrasound is a must whether it is before or after the surgery. It helps the doctor identify the vulnerabilities in your body and in your baby. You might experience some discomfort after the surgery as the effect of anesthesia wears off. In most cases, a little bit of spotting and cramping is normal.

If you feel any sort of discomfort or uneasiness, you can ask your doctor regarding the pain relieving medications that can help you with the pain and have no side-effect. Remember to follow your doctors suggestions and follow them religiously. Do take the precautionary measures.

The removal of cervical cerclage is generally carried out in the 37th week of your pregnancy. The method of removal varies from method to method. In the McDonald cerclage removal, there is no extra care needed, it can be removed in the doctor’s office itself under the influence of a local anesthesia.

Since, Shirodkar is a bit more complex, make sure to visit only best facility. In abdominal cerclage, another incision has to be made to remove the cerclage or in some cases, the cerclage is left on.

Benefits

The procedure of cervical cerclage offers certain benefits, which are:

  • Delays the premature delivery of a baby
  • Some suggest that the transvaginal cerclage can help with miscarriage as well
  • Prevents pregnancy loss

To avoid any chance of failure, you might like to visit Apollo Cradle Jubilee Hills for the procedure as it specializes in such procedures.

Why Apollo Cradle?

Apollo Cradle Jubilee Hills is equipped with the world class equipment and has a team of extremely skilled technicians and doctors who have world class knowledge and experience.

They leave no room for incompetence and keep their patients at the topmost priority. The hospital specializes in treating women and children. It is known for dealing with even the most complicated cases.

It offers remarkable services like:

  • No Price difference between Normal Delivery & C-Section (Maternity Surgery)
  • Specialised Labour and Delivery rooms
  • State-of-the-Art Ultrasound Imaging
  • Level III NICU
  • Ventilator Equipped Ambulances
  • Highly Trained Gynecologists and Nurses
  • 24X7 Pharmacy
  • Range of Maternity Packages
  • Surgical ICU

The hospital has a whole team of skilled and experienced doctors from different departments:

  • Gynecology
  • Laparoscopy
  • Pediatrics & Neonatology
  • Fertility
  • Fetal Medicine & NICU, etc.