October 2, 2024 Cervical cerclage is a surgical procedure that is performed to close or reinforce the cervix during pregnancy . It may be indicated when there is incompetent cervix ( weakened cervix or cervix ), that begins to open (dilate) prematurely, increasing the risk of miscarriage, premature water break or premature birth. Cerclage is performed to reduce the risk of late pregnancy loss (miscarriage) and premature birth , increasing the chances of carrying the pregnancy to term. Cervix incompetence can be diagnosed: Due to obstetric history : two or more consecutive pregnancy losses in the second trimester or premature birth before 28 weeks without painful contractility; Ultrasound findings : cervix measuring less than 25 mm before 24 weeks in the absence of other causes; Physical exam : observation of an effaced cervix with 1 cm or more dilation, between 14 and 27 weeks, without uterine contractility. How and when is a cerclage performed? This procedure is performed under general or locoregional anesthesia on an outpatient basis, that is, without the need for hospitalization. A tape or sutures are placed around the cervix so that it is closed and reinforced. It can be done by two approaches: Transvaginal , in which sutures are placed through the vagina; Transabdominal , in which sutures are placed through an incision in the abdomen. This technique is more invasive, even when performed using laparoscopy, and is therefore only used when transvaginal cerclage is not possible or has not been effective . The time it is carried out depends on the situation: Prophylactic : between 12-14 weeks of gestation in women with a history of cervical incompetence. It should not be carried out before 12 weeks so that the results of the aneuploidy (trisomy) screening can be available, and an early anatomical examination can be carried out, such as that of 1st trimester ultrasound; Therapy : between 14-24 weeks of gestation, when there is evidence of shortening of the cervix on ultrasound; Emergency : at any time during pregnancy if there are signs of early cervical dilation without contractions. After 24 weeks, the decision also involves considering the risks of prematurity and neonatal complications. To perform a cerclage, it is necessary to guarantee in advance: Fetal viability and well-being; Exclude the existence of an amniotic (intrauterine) infection. For this purpose, especially in cases of emergency cerclage, it may be recommended to perform an amniocentesis to evaluate the amniotic fluid. The incidence of amnionitis in emergency cerclage can reach 50%. In other cases, it is less than 5-10%; Exclude the onset of premature labor and/or premature rupture of membranes. Cervix cerclage has some contraindications : Absolute : fetal anomaly incompatible with life, uterine infection, active preterm birth, preterm premature rupture of membranes, fetal death, active uterine hemorrhage; Relative (failure rates reach 65%): cervical dilation of more than 4 centimeters, effaced cervix, protrusion of the pouch through the external os of the cervix. Cerclage is usually removed between 36-37 weeks of pregnancy, or earlier if preterm labor occurs . Removal is usually done in an office setting, without the need for anesthesia. Risks and complications The main risks associated with having a cerclage are infection, premature rupture of the membranes, bleeding, or an adverse reaction to the anesthesia. The most common complications are laceration of the cervix during labor, incompetence of the cerclage, failing to keep the uterus closed, and the need to repeat the procedure during the same pregnancy. These complications are more frequent in an emergency cerclage compared to a programed cerclage. Care after having a cervical cerclage After the procedure, it is essential to follow all the precautions recommended by the clinical team, which include : Avoid tiring activities, carrying weight and standing for long periods; Abstain from sexual intercourse as directed or for at least the first week after the procedure; Maintain a balanced diet and good hydration status; Maintain the recommended medical surveillance, which includes consultations and periodic examinations, for example, ultrasounds. After cerclage it is normal for small blood loss, mild contractions and bladder irritability to occur. However, it is important to pay attention to other symptoms and seek medical attention if the following warning signs occur : Severe abdominal pain; Bleeding; Loss of amniotic fluid; Fever; Contractions. This content was prepared by the Gynecology-Obstetrics team at Hospital da Luz. The content published in the Health Guide is intended for the general public and is provided for informational and educational purposes only. It does not replace individual medical assessment, diagnosis, or personalized clinical advice from a qualified healthcare professional. The content is produced or reviewed by physicians and other healthcare professionals at Hospital da Luz and is based on the knowledge available at the time of publication or the most recent update, as indicated at the beginning of each item.
