Cervical cerclage

Cervical cerclage

Cervical cerclage is an intervention done in pregnancy to prevent preterm birth or second trimester miscarriage due to cervical incompetence.
The string is applied to strengthen the cervix.

What are the indications of cerclage?
**history of preterm birth 
**history of second trimester miscarriage
Usually, the history entails painless dilatation of the cervix (not preceded by uterine contractions) thus establishing the diagnosis of cervical incompetence.

How does the patient with cervical incompetence present?
**feeling of pelvic heaviness
**increased vaginal discharge
**feeling of downward pressure
**low back pain
**watery vaginal discharge

Upon examining the patient, the cervix is found to be dilated without any pain.

What are the types of cervical cerclage?
**vaginal
**transabdominal

What are the contraindications of cervical cerclage?
**active infection
**ruptured membranes
**vaginal bleeding
**fetus incompatible with life
**dead fetus

At what gestational age is it applied?
Between 11-14 weeks

When is it removed?
**At 36-37 weeks of gestation in cases of vaginal delivery
**At the end of cesarean section 

What are the possible complications of cervical cerclage?
**bleeding
**infection
**ruptured membranes
**complications of anesthesia
**failure of cerclage

When is cerclage removed urgently?
**uterine contractions leading to cervical dilatation (tightening of stitch)
**active vaginal bleeding
**active infection
**ruptured membranes
**intrauterine fetal death

Dr Najeeb Layyous  F.R.C.O.G

Consultant Obstetrician, Gynecologist and Infertility Specialist