Key Takeaways for Cervical Cerclage Surgery

• Type of Procedure: Surgical.
• Duration: Usually 30 to 60 minutes.
• Anesthesia Used: Spinal, epidural, or general anesthesia (depends on the case).
• Recovery Time: Most patients can resume light activities in a few days; full recovery usually within 1 to 2 weeks (with restrictions on heavy lifting and strenuous activity)

Types of Cervical Cerclage

• Transvaginal Cervical Cerclage: Most common approach, where the cervix is stitched closed through the vagina. The suture is removed closer to delivery.
• Transabdominal Cervical Cerclage: Performed through an abdominal incision when transvaginal cerclage is not feasible or has failed in previous pregnancies.
• Laparoscopic Cervical Cerclage: A minimally invasive method using small incisions in the abdomen for quicker recovery and less scarring.
• Candidates: Recommended for those with a history of recurrent pregnancy loss, cervical incompetence, or a short cervix at risk for preterm birth.
• Risks: Potential risks include infection, bleeding, cervical injury, and premature rupture of membranes, requiring careful consultation with a healthcare provider.

Indications for Cervical Cerclage

Cervical cerclage is recommended for women who are at risk of premature birth or pregnancy loss due to a weak or short cervix. Common reasons include:

• The history of miscarriage in the second trimester is caused by cervical weakness.
• Previous preterm birth is linked to cervical problems.
• A short cervix diagnosed by ultrasound, especially before 24 weeks of pregnancy.
• Cervical dilation early in pregnancy without labor or contractions.
• Multiple pregnancies (like twins or triplets) with a weakening cervix (in selective cases).

Benefits of Cervical Cerclage

• Helps prevent miscarriage caused by a weak or short cervix.
• Reduces the risk of preterm birth, allowing the baby more time to grow and develop.
• Supports a healthier, full-term pregnancy in women with cervical insufficiency.
• Increases the chances of a successful pregnancy after previous pregnancy losses.
• Provides emotional reassurance for mothers at high risk of early labor.

Before the Cervical Cerclage Procedure

Before the procedure, your doctor will guide you through some important steps:

• Medical Assessment: Your doctor will review your medical history and conduct a physical exam to ensure you're ready for the surgery. An ultrasound may be done to check the length and condition of your cervix.
• Preparing for Surgery: You may be asked to fast for several hours before the procedure. Your doctor will explain the different anesthesia options (local, regional, or general anesthesia) and help you choose what's best for you.
• Arrangements: You might need to arrange for someone to drive you home after the surgery since you may feel groggy from the anesthesia. If necessary, discuss any medications you are taking with your healthcare provider.

During the Cervical Cerclage Procedure

Here's what happens during the surgery:

• Anesthesia: The procedure is usually done under anesthesia, which means you won't feel pain. You may get local anesthesia (numbing), regional anesthesia (epidural or spinal), or general anesthesia (asleep).
• Positioning: You will lie on your back with your feet in stirrups so the surgeon can reach your cervix.
• Placing the Suture: The surgeon uses a speculum (a tool to open the vagina) to see the cervix clearly. A strong suture (stitch) is placed around the cervix to keep it closed and prevent it from opening too early. The suture is tied to reinforce the cervix.

Types of Cerclage

• McDonald's Cerclage: A suture placed around the outside of the cervix.
• Shirodkar Cerclage: The suture is placed inside the cervix, deeper toward the uterus.
• End of the Procedure: After the suture is placed, the surgeon ensures everything is secure and the cervix is well-supported. You are then moved to a recovery room.

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Who Will You Contact for Cervical Cerclage Surgery?

• Consult Your Obstetrician/Gynecologist (OB/GYN): Your first step should be to consult your regular OB/GYN. They will review your medical history, perform exams, and decide if cervical cerclage is right for you.
• High-Risk Pregnancy Specialist (Perinatologist/Maternal-Fetal Medicine Specialist): If you have a history of miscarriages, preterm births, or other pregnancy concerns, your OB/GYN might refer you to a specialist in high-risk pregnancies. These doctors are experts in complicated pregnancies and can provide more advanced care.
• Surgical Center or Hospital: Once the decision is made for cervical cerclage, your doctor will schedule the surgery at a hospital or surgical center. They will explain what to expect before, during, and after the procedure.
• Follow Medical Recommendations: Follow your doctor's instructions about any tests, fasting, or preparations needed before the surgery.
• Recovery and Post-Operative Care: After the surgery, follow the care instructions from your doctor. This may include avoiding heavy activities, taking prescribed medications, and attending follow-up appointments to ensure proper healing.

Risks or Complications of Cervical Cerclage

• Infection in the cervix, uterus, or amniotic sac.
• Bleeding or spotting during or after the procedure.
• Premature contractions may lead to early labor.
• Cervical tearing occurs if labor begins before the stitches are removed.
• Discomfort or cramping after the surgery.
• Rupture of membranes (water breaking) earlier than expected.

Recovery After the Cervical Cerclage Procedure

After the Cervical Cerclage surgery, you will need some time to recover:

• Recovery Room: You will rest in a recovery room until the anesthesia wears off. The medical team will monitor your vital signs and ensure you're stable.
• Pain and Discomfort: It's normal to experience some mild cramping or pressure in your lower abdomen. You might also have light vaginal bleeding or spotting for a few days.
• Activity Restrictions: Avoid heavy lifting, strenuous activity, and sexual intercourse for a few weeks or as advised by your doctor. Rest as much as possible to aid your recovery.
• Follow-Up Appointments: You will need regular check-ups to monitor the cervix and ensure the stitch is holding properly. The doctor will remove the stitch around the 37th week of pregnancy to allow for delivery.
• Signs to Watch For: Call your doctor if you experience heavy bleeding, severe pain, contractions, or any unusual symptoms.
• Returning to Normal: Once your doctor clears you, you can gradually return to normal activities, but be mindful of any restrictions during your recovery period.

Lifestyle Changes after Cervical Cerclage Procedure

After undergoing a cervical cerclage surgery, your healthcare provider may recommend specific lifestyle changes to ensure the best possible outcome for your pregnancy and to reduce the risk of complications.

Keep in mind that these recommendations can vary based on individual circumstances, so it's essential to follow the advice provided by your healthcare team.

Here are some general lifestyle changes that may be suggested:

• Rest and Activity Restrictions
• Avoid Sexual Intercourse
• Hydration and Nutrition
• Stress Management
• Avoid Smoking and Alcohol
• Regular Prenatal Care
• Pay Attention to Symptoms