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Cervical Cerclage : Treatment & Diagnosis

Cervical cerclage is a surgical procedure to prevent miscarriage or premature birth in women with a weak or short cervix. It helps strengthen and support the cervix during pregnancy. Consult our experienced gynecologists or book an appointment with Pristyn Care for expert evaluation and safe treatment.

Cervical cerclage is a surgical procedure to prevent miscarriage or premature birth in ... Read More

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What is Cervical Cerclage?

Cervical cerclage is a surgical treatment where doctors place a stitch around the cervix to keep it closed during pregnancy. The procedure uses a strong suture material that wraps around the cervix in a circular pattern to reinforce the tissue. Doctors recommend this treatment when the cervix cannot support the growing pregnancy because of weakness or previous injury. The added support helps prevent premature opening, which could lead to preterm birth or pregnancy loss between 14 and 28 weeks of gestation.

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Why Is Cervical Cerclage Done?

  • Prevents early cervical opening in high-risk pregnancies.
  • Recommended for women with previous preterm births or mid-trimester losses.
  • Helps lower the risk of premature labour.
  • Suggested when ultrasound shows cervical shortening.
  • Performed after cervical surgery or trauma.

Types of Cervical Cerclage Procedures

Doctors perform different types of cerclage depending on the cervix’s condition and medical history. The chosen technique affects surgical approach, recovery duration, and whether removal before delivery becomes possible.

  • McDonald Cerclage:This is the most common vaginal stitch.It involves a purse-string suture placed around the cervix’s outer surface. Surgeons complete this cervical cerclage procedure in 15–20 minutes using spinal or general anaesthesia. Removal takes only minutes in an office setting without anaesthesia.

  • Shirodkar Cerclage: Placed higher up the cervical canal, this stitch sits closer to the internal cervical opening. Doctors make small incisions in the cervical tissue to position the suture beneath the mucosa. This approach provides stronger support for women with previous McDonald cerclage failures or severely shortened cervixes.

  • Transabdominal Cerclage: Done through the abdomen when vaginal stitches aren’t possible due to severe scarring, absent cervix, or previous trachelectomy. Surgeons place the stitch at the cervico-uterine junction before pregnancy or during early first trimester. Delivery  section because the stitch remains permanent in most cases.

How Doctors Diagnose the Need for a Cervical Cerclage Procedure

Diagnosis usually happens during early pregnancy screening when the cervix shows signs of weakness or early opening. Obstetricians combine imaging findings with medical history to determine candidacy for intervention.

  • Transvaginal ultrasound to measure cervical length: This scan provides accurate measurement of the closed portion of the cervix from internal to external opening. Serial measurements every two weeks help track progressive shortening in high-risk patients.
  • Pelvic exam for dilation or softening: Physical examination reveals whether the cervix has begun dilating or feels softer than expected for gestational age. Visible membranes bulging through an open cervix indicate advanced cervical insufficiency requiring urgent treatment.
  • Review of previous miscarriages or preterm births: Detailed obstetric history identifies patterns suggesting cervical weakness rather than other causes of pregnancy loss. Losses occurring without bleeding, cramping, or rupture of membranes between 14 and 28 weeks strongly suggest cervical insufficiency.
  • Monitoring high-risk women closely from early pregnancy: Women with known risk factors receive ultrasound surveillance starting at 14–16 weeks. Cervical length measurements continue every 1–2 weeks until 24 weeks when intervention becomes less effective.

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Step-by-Step Cervical Cerclage Procedure

The cervical cerclage procedure is usually a short surgery performed under anaesthesia and takes about 30–45 minutes from start to finish. Most patients go home the same day after a brief observation period.

  1. Pre-procedure tests and anaesthesia: Blood tests, urine culture, and fetal ultrasound confirm the pregnancy remains healthy before surgery. Anaesthesia consultation determines whether spinal or general anaesthesia suits the patient better based on medical history.
  2. Stitch placement: The surgeon inserts a speculum to visualise the cervix and uses forceps to grasp it gently. A thick suture made of non-absorbable material wraps around the cervix in a circular pattern, then gets tied to create closure.
  3. Bleeding and contractions check: After completing the stitch, the surgical team monitors for immediate complications like excessive bleeding or uterine irritability. An ultrasound confirms the fetal heartbeat remains normal after the procedure.
  4. Short observation period: Nurses check vital signs and look for vaginal bleeding, cramping, or contractions. The patient is discharged once they can walk comfortably and show no signs of complications.
  5. Follow-up within a week: The first post-procedure appointment includes an ultrasound to confirm cervical closure and fetal well-being. After that, visits occur every 2 to 4 weeks to monitor for infection, stitch displacement, or cervical changes.

Recovery and Aftercare: Things Not To Do After a Cervical Cerclage Procedure

Proper recovery care helps ensure the stitch remains effective and prevents complications during pregnancy. Most restrictions apply for the first 48–72 hours, though some continue throughout gestation.

Dos Don’ts
Take adequate rest to reduce cervical pressure and aid healing. Avoid lifting items heavier than 5 kilograms, as this strains the cervix and may weaken the stitch.
Attend follow-up scans to track cervical closure and fetal health. Avoid sexual intercourse, which can introduce infection and trigger contractions that loosen the suture.
Eat healthy and stay hydrated to support recovery and immunity. Do not stand or walk for long periods, as this raises abdominal pressure and stresses the stitch.
Monitor discharge or pain changes and report abnormalities early. Avoid straining during bowel movements to prevent pressure on the cervix.
Follow all prescribed medicines and instructions carefully. Do not miss follow-up appointments needed to assess stitch condition and healing progress.

 

Cervical Cerclage Removal: When and How It's Done

The stitch placed during the cervical cerclage procedure gets removed before labour begins to allow natural delivery unless early complications require earlier removal. This same cervical stitch that held the cervix closed throughout pregnancy must come out to permit cervical dilation during labour. Timing depends on pregnancy duration and complications.

  • Typically done around 37 weeks: Removing the stitch at this gestational age allows spontaneous labour to begin while the baby has reached maturity. Some doctors schedule cervical cerclage removal between 36–37 weeks depending on individual risk factors and cervical examination findings.
  • No anaesthesia needed for vaginal removal: McDonald cerclage removal occurs in an office setting using only a speculum for visualisation. The doctor cuts the visible suture ends and gently pulls the stitch out in one continuous motion.
  • Procedure takes a few minutes and causes mild discomfort: Most women describe the sensation as similar to a Pap smear with brief cramping. Spotting may occur for 24 hours after removal but should not progress to heavy bleeding.
  • If labour starts early, the stitch is removed immediately: Contractions against an intact cerclage can cause cervical tearing or uterine rupture. Emergency removal happens regardless of gestational age once regular contractions begin or membranes rupture.

Cervical Stitch Cost in India

The cervical stitch cost varies by hospital type, expertise of the gynaecologist, and the method used. Private hospitals charge more than government facilities but often provide shorter wait times and private rooms.

 

City Cost Range
Bangalore ₹27,000 – ₹89,000
Chennai ₹25,650 – ₹84,550
Delhi ₹28,350 – ₹93,450
Gurgaon ₹27,000 – ₹89,000
Hyderabad ₹27,000 – ₹89,000
Mumbai ₹29,700 – ₹97,900
Pune ₹27,000 – ₹89,000

Individuals should consult their doctor or hospital for a precise cost estimate. This ensures proper planning and understanding of the charges for cervical cerclage treatment.

Who Should Avoid Cervical Cerclage Treatment

Although cerclage is safe for most women, certain conditions can make the procedure unsuitable or unsafe. Placing a stitch under these circumstances increases maternal and fetal risks without improving outcomes.

  • Active infection in the uterus or cervix: Bacterial vaginosis, cervicitis, or chorioamnionitis must resolve before surgery. Placing sutures through infected tissue spreads bacteria higher into the reproductive tract and increases preterm labour risk.
  • Ongoing vaginal bleeding: Bleeding may indicate placental problems, threatened miscarriage, or cervical lesions that contraindicate surgery. Doctors must identify and address the bleeding source before considering cerclage placement.
  • Premature rupture of membranes: Once membranes break, infection risk rises dramatically and cerclage offers no benefit. The procedure cannot reverse membrane rupture or prevent delivery once this complication occurs.
  • Signs of active labour: Regular uterine contractions causing cervical change mean delivery has begun. Attempting to place a stitch during labour increases risks without stopping the process.
  • Medical issues that increase anaesthesia risk: Severe heart disease, uncontrolled diabetes, or blood-clotting disorders may make anaesthesia dangerous. Benefits of cervical cerclage treatment must outweigh anaesthesia risks in these situations.

Conclusion

Getting cervical cerclage treatment on time can help prevent preterm birth in women with a weak cervix.  Following medical advice, keeping modified activity levels, and going to regular check-ups will support a safe and full-term pregnancy. Understanding the procedure, recovery expectations, and warning signs enables informed decisions about this potentially life-saving intervention.

 

Book a consultation with a qualified gynaecologist at Pristyn Care today to discuss your cervical cerclage treatment and the next steps.

Frequently Asked Questions

Can a cervical cerclage procedure be performed under local anaesthesia?

Local anaesthesia alone does not provide adequate pain control or uterine relaxation for safe cerclage placement. Spinal or general anaesthesia remains standard practice because it prevents patient discomfort and reduces uterine contractions during surgery.

Can I travel after getting a stitch in pregnancy?

Short car trips under two hours are generally safe after the first week post-procedure. Air travel should wait until after the two-week follow-up appointment confirms the stitch remains intact and no complications have developed. Long-distance travel after 28 weeks is discouraged regardless of cerclage status.

What happens if I go into labour before cervical cerclage removal?

Doctors remove the stitch immediately once labour begins to prevent cervical lacerations or uterine damage. Leaving the cerclage in place during delivery can cause severe tears extending into surrounding tissues. Emergency removal occurs even outside regular office hours when contractions start.

Can cervical cerclage be repeated in future pregnancies?

Women who successfully carried a pregnancy with cerclage typically need the procedure in subsequent pregnancies. Each pregnancy requires individual assessment, but most doctors recommend prophylactic cerclage placement at similar gestational ages as the previous successful intervention.