What is Cervical Cerclage?

It is one of the methods used to prolong the pregnancy of pregnant women who are at risk of giving birth before the 37th week of pregnancy. Thanks to the extended pregnancy, the baby stays in the womb longer and completes its development. This procedure is performed openly or laparoscopically, through the vagina (transvaginal) or the belly (transabdominal), depending on the person’s condition. Successful results are achieved in approximately 90% of people who undergo the procedure. If there was a risk of miscarriage due to this situation in previous pregnancies, it is recommended to consult with experts in the field before planning a pregnancy.

What is Cervical Cerclage?

It is a surgical procedure that keeps the cervix closed to prevent the risk of premature birth due to insufficient (weak) cervix. During this procedure, your doctor will place a few stitches on the enlarged cervix to keep it closed. That’s why it is also known as cervical stitching. Thanks to this process, the baby will spend more time in the womb and complete its development.

To whom is Cervical Cerclage Applied?

In pregnant women, the cervix (the part of the uterus that connects to the vagina) expands when the baby is ready for birth. In some people, the cervix may dilate very early or before pregnancy due to the insufficient (weak) cervix. Since this situation may cause premature birth, some precautions must be taken. One of these measures is cervical cerclage. Who can undergo cervical cerclage procedure is listed as follows:

• People whose cervix is ​​enlarged due to surgery such as Leep (a procedure applied to the cervix) or on the cervix.
• People who have miscarriages because they have an abnormally shaped cervix
• People with damage to the cervix
• People with a history of cervical cerclage in previous pregnancies
• People who gave birth before the 34th week in previous pregnancies
• It is applied to people who had miscarriages due to dilation of the cervix in previous pregnancies.

If you have the complaints mentioned above, it is recommended that you be examined by a physician as soon as possible. If the physician deems it appropriate to apply cervical cerclage after the examination, it is recommended to do it between the 12th and 14th weeks of pregnancy. Otherwise, the procedure cannot be performed as the cervix will thin as the pregnancy progresses.

What should be done before the Cervical Cerclage Procedure?

Cervical cerclage is a surgical procedure applied to the cervix. Therefore, there are points to consider before the procedure. These points are listed as follows:

• Before the procedure, the patient’s health history must be evaluated by a physician.
• The physician must be informed about pregnancy, uterine surgery and procedures. It is evaluated whether there are any complications in these surgical procedures.
• In case of infection, cervical mucus or amniocentesis or amniotic fluid samples can be taken from the patient and examined. Amniotic fluid is collected by entering the abdominal area with a needle.
• Before the cervical cerclage procedure, the cervix must be examined by placing a speculum (metal device used to expand the vagina) into the vagina.
• It needs to be examined with vaginal ultrasound.
• The physician may ask you to abstain from sexual intercourse 1 week before the procedure.
• Any questions the patient has before the procedure are answered. The patient should be comfortable and carefree during the procedure.

How is Cervical Cerclage Done?

During the cervical cerclage procedure, you lie on the examination table with your legs open and your feet in stirrups. Local or epidural anesthesia is applied to the patient to avoid any pain before the procedure. In order to completely prevent the pain that may occur during the procedure, the patient is given the necessary painkiller supplements. While local anesthesia is administered, there may be a slight feeling of tightness and pain in the cervix. This feeling will pass in a short time. After the anesthesia takes effect, the physician tightly stitches the cervix with the necessary surgical materials to eliminate the weakness in the cervix.

Is Pain Felt After the Cervical Cerclage Procedure?

Light bleeding, cramping, pain and spotting may occur for a few days after the procedure. The pain felt after the procedure should not be longer than the menstrual period. Painkillers recommended by the doctor can be used for pain.

After the procedure, burning sensation while urinating may occur until recovery occurs. These felt pains vary from person to person.

If bleeding, pain, cramping and spotting occur for a long time and are intense, it is necessary to report this situation to the physician.

When Should Cervical Cerclage Stitches Be Removed?

It is recommended that the stitches placed on the vagina during the cervical cerclage procedure be stopped until the 37th week of pregnancy. When it comes time to remove the cerclage, many of the application stages of the procedure are applied.

As is done during the procedure, you lie on the examination table with your legs apart and both feet in stirrups. Your doctor will remove the stitches from the cervix. You should not move while the stitches are being removed.

If labor water breaks before it is time to remove the cerclage or if there is a need to start labor, the cerclage can be removed earlier.

What are the Risk Factors of the Cervical Cerclage Procedure?

Cervical cerclage is a procedure that varies from person to person. Depending on the patient’s condition, if the advantages of the procedure outweigh its risks, cervical cerclage is recommended for that person. As with almost every medical procedure, this procedure has certain risks. Risks to be considered are listed as follows:

• Infection
• Damage to the cervix
• August
• slipping of stitches
• Premature rupture of the membrane (the membrane in which the baby is located in the womb)
• Premature birth if the membrane ruptures
• If premature birth occurs, risk factors of the procedure such as wounds on the cervix or rupture of the uterus may occur because the stitches have not yet healed.

What should be considered after the Cervical Cerclage Procedure?

After the procedure, the patient is hospitalized for a few hours due to the risk of any complications. If the patient does not experience any complications, he can go home the same day.

The physician can give the patient appropriate antibiotic treatment to prevent the risk of infection. It is recommended that the antibiotic medication prescribed to the patient be taken without interruption.

It is recommended that the patient rest after the procedure so that the stitches heal properly. Upon the doctor’s advice, sexual intercourse, sports and lifting heavy objects should be avoided for approximately 10 days. There is no harm in patients returning to their daily activities such as school and work one day after the procedure.

If conditions such as high fever, bad odor from the vagina, contractions at regular intervals, lower groin pain, and excessive bleeding occur after the procedure, the doctor who performed the procedure should be consulted immediately.

Physician appointments should not be missed to observe pregnancy and cervical cerclage procedure.

Frequently Asked Questions

It is among the most frequently performed procedures due to cervical weakness, which is common in our country. There are some most frequently asked questions to clear up the doubts in the minds of people who want to have the procedure done. Frequently asked questions about the procedure are as follows:

How Long Does Pregnancy Extend with Cervical Cerclage Procedure?

As is known, the main purpose of this procedure is to prevent premature birth and increase the duration of pregnancy. Pregnancy can last up to 5 weeks on average. This extension period varies from person to person. If labor begins before the end of 5 weeks, cervical cerclage can be terminated earlier.

What is the Examination Process After Cervical Cerclage?

The patient should be kept under control during and after the Cervical Cerclage procedure. In addition to the medications used with the doctor’s recommendation, regular ultrasound images should be checked. In order to avoid any complications (a situation that negatively affects the course of the disease), regular hospital check-ups should be performed within the time period recommended by the physician.