A dear friend of mine had to have her cervix stitched in the past week after a routine check up showed she was prematurely dilated at 20 weeks.
The most surprising thing about this incident was how little most of us care about family medical history. Though an incompetent cervix is not necessarily hereditary, her mother had to have her cervix stitched for four pregnancies. It is important to discuss such health issues not to frighten but to prepare ourselves and if possible take preventive actions.
Cervical cerclage, also known as a cervical stitch, is a treatment for cervical incompetence or insufficiency, when the cervix starts to shorten and open too early during a pregnancy causing either a late miscarriage or preterm birth. Usually the treatment is done in the second trimester of pregnancy commonly for a woman who had either one or more late miscarriages in the past, or is carrying more than one baby.
The treatment consists of a strong suture being inserted into and around the cervix early in the pregnancy, usually between weeks 12 to 14, and then removed towards the end of the pregnancy when the greatest risk of miscarriage has passed.
After the cerclage has been placed, the patient will be observed for at least several hours (sometimes overnight) to ensure that she does not go into premature labor. The patient will then be allowed to return home, but will be instructed to remain in bed or avoid physical activity (to include coitus) for two to three days, or up to two weeks. Follow-up appointments will usually take place so that her doctor can monitor the cervix and stitch and watch for signs of premature labor.
While cerclage is generally a safe procedure, there are a number of potential complications that may arise during or after surgery. These include:
◾risks associated with regional or general anesthesia
◾premature rupture of membranes
◾infection of the cervix
◾infection of the amniotic sac (chorioamnionitis)
◾cervical rupture (may occur if the stitch is not removed before onset of labor)
◾injury to the cervix or bladder
◾Cervical Dystocia with failure to dilate requiring Cesarean Section
◾displacement of the cervix
The success rate for cervical cerclage is approximately 80-90% for elective cerclages, and 40-60% for emergency cerclages. A cerclage is considered successful if labor and delivery is delayed to at least 37 weeks (full term).
For women who are pregnant with one baby (a singleton pregnancy) and at risk for a preterm birth, when cerclage is compared with no treatment, despite there being a reduction in preterm birth, there is no reduction in deaths of the baby before or after birth, or reduction in illness in the baby after birth.