Should I have a cerclage procedure?
Women undergoing troubling pregnancies in the Greater Los Angeles area rely on compassionate Dr. Steve Rad, a double-board certified Obstetrician-Gynecologist with sub-specialty training in Maternal-Fetal Medicine. Our talented OB/GYN always puts your welfare first and practices with a conservative hand.
A prime example of this well-rounded attitude appears when consulting with women considering a cervical cerclage. The cervical cerclage procedure can be an effective way of preventing preterm delivery or premature labor caused by cervical incompetence (also called a weak cervix). Indeed, the procedure is successful in almost 90% of cases. However, diagnosing an incompetent cervix can be difficult and is often inaccurate.
Research suggests that cervical cerclage reduces the risk of premature delivery in pregnant women with proven cervical insufficiency. However, the timing of cervical cerclage can also affect the outcome. Emergency cervical cerclage done in the presence of advanced cervical change and prolapsed membranes have a poorer outcome, according to the Mayo Clinic.
Dr. Rad excels in accurately diagnosing and advising patients on cervical insufficiency.
What is a cervical cerclage?
Cerclage refers to a hoop that’s stitched into the cervix. There are two methods of performing cervical cerclage; the most common is through the vagina, which is called a transvaginal cervical cerclage. Less common is transabdominal cerclage – which goes through the abdomen.
Why is cervical cerclage done?
Before pregnancy, the cervix is long, firm, and closed. But during pregnancy, the cervix decreases in length (effacement), softens, and opens (dilation). If your cervix is too short (incompetent), problems may arise. An incompetent cervix may open too soon, resulting in loss of a pregnancy or premature birth.
This is where Dr. Rad’s expertise comes into play. During your consultation and evaluation, he can assess whether surgical intervention to prevent premature birth is necessary. Signs a cervical cerclage may be required include:
- Second-trimester pregnancy loss related to painless cervical dilation
- Previous cerclage because of painless cervical dilation
- A short cervix (cervical length is less than 25mm) before 24 weeks of pregnancy
Which patients can’t have cerclage?
The cerclage procedure is not recommended for every patient at risk for preterm birth. The following factors may exclude an expectant mother:
- Active vaginal bleeding
- Active preterm labor
- An intrauterine infection
- Preterm rupture of membranes
- Multiple births (twins, etc.)
- The fetus is incapable of life
- The amniotic sac protrudes through the cervix (prolapsed fetal membranes)
- Cervical laceration
- Any prior cervical procedures or trauma, including loop electrode excisional procedure (LEEP), cone biopsy, prior cervical lacerations, or repetitive cervical dilation and/or pregnancy terminations
- History of second-trimester miscarriages
How to prepare for cerclage
If Dr. Rad decides that you are a good candidate for cerclage surgery, he will likely do an ultrasound to check the baby’s vital signs and rule out any major birth defects. The doctor may then take a swab of your cervical secretions or perform an amniocentesis to check for infection. If there is an infection, the procedure will be called off.
Ideally, a cervical cerclage procedure is done between 12 and 14 weeks of gestation (after 14 weeks the procedure is called an emergent cerclage). The procedure can be performed up until week 23 if an exam demonstrates that the pelvis is beginning to open. The operation is typically avoided after week 24 because of the potential danger of nicking the amniotic sac and triggering premature rupture of membranes.
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The cervical cerclage procedure
Typically performed on an outpatient basis, cervical cerclage is usually accomplished in one of three surgical procedures:
McDonald operation
The doctor uses a needle to sew cervical stitches (sutures) around the outside of the cervix where it has begun to dilate.
Shirodkar operation
A transvaginal cerclage. The physician uses forceps to pull the cervix toward him while pulling back the walls of the vagina. He then makes small incisions in the cervix and threads tape through them to close the cervix.
Transabdominal cerclage (TAC)
The doctor uses a strong, synthetic band to hold the cervix shut. This band is applied via an abdominal incision. This band can stay in place for future pregnancies.
The doctor usually uses general anesthesia with this surgical procedure. Patients who’ve had transabdominal cerclage generally give birth via C-section.
How to recover from cervical cerclage?
After cervical cerclage, your doctor will typically do an ultrasound to check on the baby’s well-being.
Many women have some spotting, cramps, vaginal discharge, and painful urination for a few days after the procedure. Over-the-counter pain relievers are recommended for pain or discomfort. If your health care provider used stitches to reposition vaginal tissue affected by incisions in your cervix, you might notice the passage of the material in two to three weeks as the stitches dissolve.
If you had history-indicated cervical cerclage, you’ll likely be able to go home after you recover from the anesthetic. As a precaution, your healthcare provider might recommend avoiding sex for at least a few weeks.
If you had cervical cerclage because your cervix had already begun to open or an ultrasound showed that your cervix is short, you might need to remain on bedrest in the hospital for observation. As a precaution, your health care provider might recommend limiting physical activity and sex until delivery.
Your health care provider will continue to monitor you closely for signs or symptoms of preterm labor.
More about Dr. Rad
Dr. Rad and his world-class obstetrics and gynecology team at Los Angeles Fetal and Maternal Care Center understand your healthcare needs before, during, and after birth. Our doctors provide compassionate care and help you understand your pregnancy, answer questions, and provide emotional support to safely navigate your pregnancy.
Call us at (844) 473-6100 or schedule your consultation online. We are currently accepting new patients.
We are conveniently located for patients throughout Southern California and the Los Angeles area at locations in or near Beverly Hills, Santa Monica, West Los Angeles, West Hollywood, Culver City, Hollywood, Venice, Marina del Rey, Malibu, Manhattan Beach, Newport Beach, Irvine, and Downtown Los Angeles. We also offer in-home prenatal care and a fly-in program for out-of-town and international patients. Dr. Rad even travels to patients who need him throughout the U.S. and around the world.
If you can’t make it to Dr. Rad, he also offers virtual consultations worldwide.
Call (844) 473-6100 or click here to schedule online
