What is a cervical stitch and why is it done?
Cervical stitch application or cervical cerclage is the placement of a stitch at the cervix ( the neck of the uterus) . This is done to prevent you from going into preterm labour ( prior to 37 weeks of pregnancy)
or having a miscarriage after 16 weeks of pregnancy. In the preterm period, the cervix should normally belong, firm and closed. However, due to some reasons, it may shorten and open up.
Who are candidates for application of a cervical stitch application or cervical cerclage?
If you have a history of previously having had a miscarriage after 16 weeks.
If there’s a history of preterm delivery in a previous pregnancy.
If there’s a history of PPROM which means leaking due to the water bag breaking prematurely in a previous pregnancy (prior to 37 weeks)
If you have a history of prior cerclage due to painless cervical dilatation in the second trimester
If on ultrasound at 16-24 weeks in your current pregnancy, your cervix has a length of 25 mm or less.
If you’ve had some surgery on the cervix like a cone biopsy
You are a good candidate for cervical cerclage.
Are there some contraindications to cervical cerclage?
The cervical stitch is not applied in case you already have active leaking due to breakage of the water bag
You have active vaginal bleeding
You are already in established preterm labour with uterine contractions
You have signs of infection
You have twins or higher-order pregnancy
You have a fetal congenital abnormality that is not compatible with life
When is a cervical stitch placed?
This is done at 12-14 weeks of pregnancy and may even be applied up to 24 weeks.
A “ rescue cerclage” is an emergency cerclage that may be placed even later if the cervix has become really short and membranes are bulging through the short and open cervix, threatening to abort or leading to preterm delivery. This type of stitch carries more risks and doesn’t work always.
How can this stitch be placed?
Most times it is done vaginally; rarely it may need to be placed abdominally if the cervix is too short, lacerated or it is technically difficult to place by the vaginal route.
Are there any alternatives to cervical cerclage?
Vaginal progesterone pessaries or gels are an alternative to this and occasionally both cervical cerclage and progesterone vaginal capsules may be needed together .
What are the risks of cervical cerclage ?
Bleeding
Infection
Rupture of the water bag leading to leaking
Precipitation of preterm labour or mid-trimester abortion
Injury to the bladder or cervix
Sometimes it may not be possible at all to place the cervical stitch as the cervix is too short or too open .
Is there anything you need to be watchful about post cervical cerclage?
If you have spasmodic crampy pains , bleeding , leakage of an intense watery fluid , smelly discharge , you must talk to your obstetrician right away .
When is this stitch removed?
The stitch is removed at 37 weeks or earlier if you go into labour . If you go into labour when the stitch is still in place , you must inform your doctor .
