Cervical cerclage is a procedure used to temporarily stitch the cervix closed in pregnant women with a history of miscarriage or premature.  Normally, the cervix, the structure located at the lowest part of the uterus and extending into the vagina, remains closed until the third trimester of pregnancy. The cervix then progressively dilates during labor allowing delivery of the baby.  However, sometimes the cervix opens too early in the pregnancy. These women may have an incompetent cervix, and may be candidates for cervical cerclage. A cervical cerclage procedure will help keep the cervix closed as the baby grows. The stitches are generally removed at the 37^th week of pregnancy, allowing for a normal delivery.

When is it used?

• Cervical cerclage may be recommended if you have a history of miscarriage during the second trimester of pregnancy.

• The procedure may be done at the beginning of your second trimester or at the time your doctor finds that your cervix is opening too early.

Note that bedrest - sometimes for several months - is an alternative treatment method for an incompetent cervix.

What happens during the procedure?

You will receive either a general, spinal, or epidural anesthetic, depending on your doctor's preference. Your doctor will then place stitches around your cervix to hold it firmly closed.

What happens after the procedure?

• You may stay in the hospital for several hours or overnight so that you can be monitored for premature contractions or labor.

• Your doctor may prescribe a medicine to reduce the chance that the procedure will induce premature labor.

• Your doctor will advise you when you can resume having sexual intercourse. (Ask your doctor if he or she does not provide this information.)

How long do the stitches remain in place?

The stitches are generally left in the cervix until the 37^th week of pregnancy. However, if contractions start or your water breaks while your cervix is sewn shut, you should call your doctor immediately.

What are the benefits of this procedure?

Cervical cerclage successfully prevents miscarriage or premature delivery due to cervical incompetence in 85% to 90% of cases. If you undergo cervical cerclage, your doctor will probably also recommend the  procedure for each of your next pregnancies.

What are the risks? 

The risks associated with cervical cerclage are rare. They include:

• The risks associated with general anesthesia.  If your doctor plans to perform the procedure under general anesthesia, discuss these risks with them. Note that cervical cerclage is commonly done under a spinal anesthetic.

• Premature labor.

• Cervical infection - Infection may cause fever, chills, cramping, or a vaginal discharge that smells badly.

• Cervical rupture - If you go into labor while the stitches are still in place, the contractions may causes tears in the cervix. Therefore, it is important that the stitches be removed prior to or during early labor. Anesthesia is not generally used when the stitches are taken out.