Cervical Cerclage

Cervical cerclage is a surgical procedure used to prevent preterm birth or miscarriage by placing stitches around the cervix to keep it closed during pregnancy. This procedure is often recommended for women with cervical insufficiency, a condition where the cervix begins to dilate prematurely, leading to potential complications.

Cervical cerclage is a surgical procedure used to prevent preterm birth or miscarriage by placing stitches around the cervix to keep it closed during pregnancy. This procedure is often recommended for women with cervical insufficiency, a condition where the cervix begins to dilate prematurely, leading to potential complications.

Cervical Insufficiency (Incompetent Cervix)

Cervical insufficiency, also known as an incompetent cervix, occurs when the cervix begins to open too early during pregnancy, often without pain or contractions, leading to a risk of preterm birth or miscarriage.

  • Causes: The exact cause of cervical insufficiency is not always clear, but it can be associated with:
    • Congenital structural abnormalities of the cervix
    • Previous cervical surgery or trauma (e.g., cone biopsy, LEEP procedure)
    • Dilation and curettage (D&C) procedures
    • Hormonal factors affecting cervical strength
  • Symptoms: Cervical insufficiency often does not present noticeable symptoms until late in the pregnancy, when it may be too late to intervene effectively. When symptoms do occur, they can include:
    • A sensation of pelvic pressure or fullness
    • Backache
    • Mild abdominal cramps
    • Changes in vaginal discharge
    • Light bleeding or spotting
  • Risk Factors: Factors that increase the risk of cervical insufficiency include:
    • History of second-trimester miscarriage
    • Previous preterm birth
    • Structural cervical abnormalities
    • Cervical trauma from surgical procedures
  • Treatment Options: The primary treatment for cervical insufficiency is cervical cerclage. Other options include bed rest, progesterone supplementation, and frequent monitoring with ultrasound.

Cervical Cerclage Procedure

Cervical cerclage is performed using various techniques, depending on the individual’s medical history and specific condition. The two main types of cervical cerclage are:

Transvaginal cerclage procedures, such as the Shirodkar or McDonald sutures, are typically performed by the patient’s obstetrician.

  • Procedure: This is the most common type of cerclage, performed through the vagina. A strong suture (stitch) is placed around the cervix to keep it closed.
  • Timing: Typically performed between 12 and 14 weeks of pregnancy, but can be done later if necessary.
  • Benefits: Minimally invasive, lower risk of complications, and quick recovery time.
  • Risks: Infection, cervical laceration, preterm premature rupture of membranes (PPROM), and preterm labour.
At MIGYNAE, we offer transabdominal cerclage as a laparoscopic or open interval procedure, providing options for patients requiring cervical support.
  • Procedure: This type of cerclage is performed through an abdominal incision and is usually recommended for women with significant cervical shortening or previous failed transvaginal cerclage.
  • Timing: Typically performed before pregnancy or early in pregnancy (before 12 weeks).
  • Benefits: Provides stronger support for the cervix and is less likely to fail in women with a history of cervical insufficiency.
  • Risks: Higher risk of surgical complications, longer recovery time, and increased risk of infection.

The causes of cervical insufficiency are often multifactorial and can include:

  • Congenital Factors: Some women are born with a structurally weak cervix.
  • Surgical History: Previous cervical surgeries, such as cone biopsies or LEEP procedures, can weaken the cervix.
  • Trauma: Trauma to the cervix during previous pregnancies or surgical procedures.
  • Hormonal Factors: Hormonal imbalances that affect the structural integrity of the cervix.
  • Genetic Conditions: Certain genetic conditions can predispose a woman to cervical insufficiency.

Cervical insufficiency often does not present noticeable symptoms until the cervix begins to open. When symptoms do occur, they can include:

  • Pelvic Pressure: A feeling of pressure or fullness in the pelvis.
  • Backache: Persistent or intermittent lower back pain.
  • Abdominal Cramps: Mild, recurrent abdominal cramps.
  • Vaginal Discharge: Changes in vaginal discharge, such as increased volume or mucus.
  • Bleeding or Spotting: Light vaginal bleeding or spotting, especially in the second trimester.

Several factors can increase the risk of developing cervical insufficiency, including:

  • History of Miscarriage: Previous second-trimester miscarriages can indicate cervical insufficiency.
  • Preterm Birth: A history of preterm birth increases the risk of cervical insufficiency in subsequent pregnancies.
  • Cervical Surgery: Procedures like cone biopsy or LEEP can weaken the cervix.
  • Congenital Abnormalities: Structural abnormalities present from birth.
  • Multiple Pregnancies: Carrying twins or more can put extra pressure on the cervix, increasing the risk of insufficiency.
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We are a general gynaecology clinic based in Melbourne, dedicated to the latest Minimally Invasive (MI) gynaecological diagnostic and surgical techniques. We are leaders in laparoscopic and cutting-edge robotic “keyhole” surgery.

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At MIGYNAE, we provide care to all individuals with gynaecological and reproductive health needs, including those with female reproductive organs, regardless of gender identity or assignment at birth. We also welcome trans women and others seeking our specialist expertise.

We acknowledge the Traditional Owners of the land on which we work and live, the Wurundjeri Woi-wurrung and Bunurong peoples of the East Kulin Nations. We pay our respects to their Elders past, present, and emerging, and celebrate their rich stories, cultures, and traditions.

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