Cervical cerclage

What is a cervical cerclage?

A cervical cerclage, sometimes referred to as as cervical stitch, is a small operation to reinforce the cervix with stitches and keep it closed during pregnancy.

Why is it done?

The cervix normally remains closed during pregnancy until the baby comes to term and the mother’s waters break. However, the pressure caused by a growing baby can sometimes cause the cervix to shorten and widen. If the cervix is weak, it might open too early, causing a miscarriage or a preterm birth.

Cervical cerclage is carried out if doctors think there might be a risk of this occurring. You may be considered at risk if you have a history of second-trimester pregnancy loss, or if the obstetrician has detected a shortening of your cervix during a routine pregnancy scan.

Cervical cerclage is not generally recommended if you’re carrying more than one baby, of if you have vaginal bleeding or an intrauterine infection.

What are the different types of cervical cerclage?

There are three types of cervical cerclage, two are transvaginal procedures, and the other is transabdominal cerclage:

Transvaginal cervical cerclage

Shirodkar stitch

This type of cervical cerclage is where the stich is placed under the cervix surface, close to where it meets the womb. 

MacDonald stitch

This stitch is placed further down the cervix, and is nearer to the vagina. 

Transabdominal cerclage

Also referred to abdomen cerclage, this is where the cervix is stitched closed at the top of the cervical opening in the abdomen area. This is a permanent procedure and is done when other options of cervical cerclage are not suitable. 

What does it involve?

Before the operation you’ll have an ultrasound and a swab taken to check for infection.

Cervical cerclage is an outpatient procedure so you can usually go home on the same day. Most of the time the procedure is carried out via the vagina, but in some cases you may need a transabdominal cervical cerclage, which involves making an incision in the abdomen.

After the operation you’ll have another ultrasound to check that everything has gone well, and you’ll be advised on any activity to avoid for the next few weeks.

What's involved in cervical cerclage aftercare?

If you had a transvaginal cervical cerclage, this will be removed at around 36-37 weeks into pregnancy. If you had a transabdominal cervical cerclage, this is not generally removed before labour, and you’ll give birth via a caesarean.

What are the alternatives to this treatment?

Because of the risks of bleeding, infection, or cervical damage, a cervical cerclage is not always recommended. The main treatment alternative is to take high dosages of progesterone to prevent an early labour.

Additionally, some UK hospitals are trialling alternative method of reinforcing the cervix, called the Arabin pessary.