Cerclage 101: Exploring Cervical Stitching

By on March 14, 2024

During the Healthful Woman podcast, hosted by Dr. Fox featuring guest Dr. Andrei Rebarber called, “Cerclage” At Your Cervix!” both doctors discuss the surgical procedure called a cerclage. This podcast reviews when a patient needs a cerclage and when the procedure may be considered controversial. Learn whether you may be a candidate for a cerclage at Maternal Fetal Medicine Associates in New York City.  

What is a Cerclage?

The cervix can become too short and may dilate early in pregnancy. The cerclage is a surgical procedure designed to address the condition known as cervical incompetence. Doctors are unsure of how or why a weakened cervix occurs in many cases, and there is no predictable way to evaluate the competency of a cervix prior to pregnancy. A cerclage is a surgical procedure that maintains the cervix closed along the pregnancy in the setting of a short or dilated cervix using surgical-grade sterile sutures. It can help hold the cervix closed during your pregnancy to prolong the pregnancy to a full-term gestation.

Am I a Candidate for a Cerclage?

Doctors evaluate three categories when deciding if you are a candidate for cerclage surgery. First, they would look at your medical history and see whether your previous pregnancies have been miscarriages or preterm births and can be attributable to a weakened cervix, then a History Indicated Cerclage may be advised. Secondly, they might take a transvaginal ultrasound of the cervix, and if the results indicate a shortened cervix with no dilation currently present, depending on the circumstances, this may result in a recommendation for an Ultrasound-Indicated Cerclage. Finally, they may perform a pelvic examination, and if = the exam indicates the cervix has begun dilating before the 24th week of gestation, then an Exam Indicated Cerclage may be advised. Needing a cerclage can vary from one pregnancy to another. An individual with suspected cervical incompetence in the past will not necessarily have it again. Reviewing your history, physical exam, and current pregnancy transvaginal ultrasound evaluation of the cervix will ensure that your cerclage is performed for the proper indications. Dr. Fox stated, “Within each subgroup, there are criteria for who is and is not a good candidate.”

Cerclage Procedure

The cerclage is most often performed vaginally, though a more permanent transabdominal approach exists. The procedure will begin with the administration of regional anesthesia (e.g., spinal, epidural). The cervix will be closed with nonabsorbable sutures to prevent or delay preterm birth/miscarriage. If the patient reaches full term, the vaginal cerclages are removed at 37 weeks. After the procedure the patient can have slight cramping and spotting.

Cerclage Risks

Dr. Rebarber expresses the importance of ensuring cerclage surgery is necessary. “A cerclage holds the cervix, and if the uterus on top is contracting, it’ll rip through the cervix and cause more damage. So, you are trying to identify the case in which it is truly isolated to just a weakness in the cervix.” Serial cervical assessment of the cervical length can ensure that the surgery is required in certain borderline situations and should not impact pregnancy outcomes. Having a stitch in place can cause irregular spotting, discomfort, and preterm contractions. The best way to ensure that a cerclage is suitable for you is through a private appointment with one of the doctors at Maternal Fetal Medicine Associates.

Schedule an Appointment

If you suspect that you have a weakened cervix or a case of cervical competence, you must schedule an appointment with a doctor at Maternal Fetal Medicine Associates in New York City by filling out the online contact form on our website to evaluate your cervix. A cerclage can help you maintain your pregnancy and provide the peace of mind you need.

Maternal Fetal Medicine blogs are intended for educational purposes only and do not replace certified professional care. Medical conditions vary and change frequently. Please ask your doctor any questions you may have regarding your condition to receive a proper diagnosis or risk analysis. Thank you!