Cervical Stitch (Cerclage) in Pregnancy: When It Is Needed and How It Prevents Preterm Birth
Cervical stitch (cerclage) in pregnancy: when it is needed, how it is done, and how it helps prevent preterm birth.
Cervical Stitch (Cerclage) in Pregnancy: When It Is Needed and How It Prevents Preterm Birth
In short: A cervical cerclage is a stitch placed around the cervix during pregnancy to strengthen a weak cervix and prevent second-trimester miscarriage and preterm birth. It is recommended after three or more preterm births or second-trimester losses, or when the cervix measures 25 mm or less before 24 weeks in a woman who has had a previous preterm birth or late miscarriage. It is usually placed at 11–14 weeks and removed at 36–37 weeks, and it does not help in twin pregnancies.
What is a cervical stitch?
A cervical cerclage is a preventive procedure in which a surgical stitch is placed around the cervix to strengthen it and keep it closed until the pregnancy reaches term. It gives the cervix extra support and helps keep the mucus plug in place, which protects the pregnancy from infection.
What is cervical weakness and how does it present?
Cervical weakness (cervical insufficiency) means the cervix opens without pain and without contractions, leading to second-trimester miscarriage or preterm birth. A woman may notice pelvic heaviness, downward pressure, low back pain, increased vaginal discharge or a watery discharge.
When is a cervical stitch recommended?
There are three situations in which a cervical stitch may be advised:
• History-indicated stitch: three or more previous preterm births (before 37 weeks) or second-trimester miscarriages, with painless opening of the cervix.
• Ultrasound-indicated stitch: a cervical length of 25 mm or less on transvaginal ultrasound before 24 weeks, in a woman who has had a previous preterm birth or second-trimester miscarriage, previous surgery to the cervix, or an emergency caesarean section at full dilation.
• Emergency (rescue) stitch: when the cervix has already started to open and the membranes are visible, without contractions. It is usually placed before 24 weeks, and may be considered up to 28 weeks in selected cases.
When do we start measuring cervical length by ultrasound?
For women at risk of preterm birth or late miscarriage, cervical length is measured by repeated transvaginal ultrasound scans from 14 to 24 weeks of pregnancy.
Does a cervical stitch help in twin pregnancy?
No. A cervical stitch does not prevent preterm birth or miscarriage in twin pregnancies, so it is used only in pregnancies with one baby.
What are the types of cervical stitch?
• Vaginal stitch: the most common approach, using the McDonald or Shirodkar technique.
• Abdominal stitch: placed by laparoscopy or open surgery, usually when a vaginal stitch has failed in a previous pregnancy.
When is the stitch placed?
A planned stitch is usually placed between 11 and 14 weeks of pregnancy, after the baby has been checked by ultrasound.
What tests are needed before a cervical stitch?
• An early ultrasound check of the baby to look for chromosomal or structural abnormalities.
• For an emergency stitch: infection markers such as C-reactive protein (CRP) and white blood cell count, to rule out infection inside the womb.
When should a cervical stitch not be placed?
A stitch should not be placed if there are signs of infection inside the womb, vaginal bleeding, ruptured membranes, active contractions, a fetal abnormality incompatible with life, or if the baby has died.
What are the possible complications?
Cervical cerclage is generally safe, but possible complications include bleeding, infection, rupture of the membranes, bladder injury, anaesthetic complications and failure of the stitch.
When is the stitch removed?
The stitch is usually removed at 36–37 weeks in preparation for a vaginal birth, or during a planned caesarean section. It must be removed immediately if any of the following occur:
• Labour contractions with opening of the cervix.
• Active vaginal bleeding.
• Active infection or ruptured membranes.
• Death of the baby in the womb.
Dr Najeeb Layyous F.R.C.O.G
Consultant Obstetrician, Gynecologist and Infertility Specialist
The finest doctor in Jordan — may God bless him and his whole medical team. A doctor in every sense of the word. I advise anyone planning a pregnancy to visit Dr. Najeeb Layyous. His manner is wonderful, always smiling, with the highest ethics; he gives every patient her due, and the patient’s comfort matters most to him. We had been to many doctors and none understood and treated my case except him. Special thanks to him and the whole team, and to Dina in particular — a lovely person. I recommend anyone considering IVF or pregnancy to visit his clinic.