Surgery to Close the Cervix (Cervical Cerclage)

What is cervical cerclage?

Cervical cerclage is a surgical procedure that may be done to stitch the cervix closed during pregnancy. The cervix is the lowest part of the uterus that extends into the vagina. It is the opening from the uterus into the birth canal. Babies pass through the cervix during birth.

This procedure is also called a cervical stitch.

When is it used?

Normally the cervix stays closed during pregnancy until the third trimester. Some women have trouble carrying a pregnancy to full term because of a weakness in the cervix that lets the cervix open too early. As a result, the baby may be born too early. One of the ways to treat a weak cervix during pregnancy is to put a stitch around the cervix to keep it closed while the baby grows. Cervical cerclage can help prevent a miscarriage or early birth.

If you have a history of second-trimester miscarriages, a cerclage may be done at the beginning of your second trimester. Otherwise, it may be done at the time your healthcare provider finds that your cervix is opening too early. It can be done only if you are not yet having contractions.

An additional treatment for a weak cervix is bed rest for up to several months. You also should not have sexual intercourse.

How do I prepare for the procedure?

Follow the instructions provided by your healthcare provider. If you are going to have a general anesthetic, eat a light meal such as soup or salad the night before the procedure. Do not eat or drink anything after midnight before the procedure. Do not even drink coffee, tea, or water.

What happens during the procedure?

You will be given a general or regional anesthetic. Your healthcare provider will then stitch 1 or 2 bands of strong suture thread around your cervix. Your provider will tighten the thread to hold the cervix firmly closed.

What happens after the procedure?

• You may stay in the hospital for several hours or overnight so that you can be checked for premature contractions or labor.
• Your healthcare provider may give you medicine to lower the chance that the procedure will start early labor.
• Ask your provider if and when you can have sexual intercourse again during the pregnancy.

How long is the cerclage thread left in?

The thread is removed when your provider decides the baby is old enough and safe to deliver. This is generally around the 36th to 37th week of pregnancy. If you have contractions or your bag of water breaks while the thread is still in, call your healthcare provider right away.

If your baby is born by C-section rather than vaginally, the thread is usually removed after the C-section is done. Sometimes the thread is left in.

What are the benefits of this procedure?

Cervical cerclage prevents miscarriage or early delivery caused by a weak cervix. The procedure is successful in most cases. You may need cervical cerclage again for each of your next pregnancies.

What are the risks?

• There are some risks associated with each kind of anesthesia. Discuss the risks of anesthesia with your healthcare provider.
• The procedure may cause early labor.
• It may cause the bag of water to rupture.
• The cervix may get infected. An infection could infect the baby or cause early labor.
• If you go into labor with the stitch in your cervix, your contractions may tear open your cervix. It is important that the stitch be removed before you go into labor or as soon as possible after you start labor. It is usually taken out without anesthesia.
• The procedure could damage the bladder or rectum.

All of these complications rarely occur.

When should I call my healthcare provider?

Call your provider if you have any of the following symptoms:

• contractions
• lower abdominal or back pain that comes and goes like labor pains
• vaginal bleeding that seems to be more than your healthcare provider has told you to expect
• a fever over 100°F (37.8°C)
• chills
• a bad-smelling vaginal discharge
• a sudden leakage of fluid from your vagina (your bag of water breaks)