17970 Cervical Cerclage

Overview

Cervical cerclage is a procedure that puts a strong stitch around the cervix — the lower part of the womb that opens during labour. The stitch helps keep the cervix closed when it is weak or short. This can lower the chance of the baby being born too early (preterm birth).

No. Cervical cerclage is not common. It is offered only to a small group of pregnant women with specific risk factors.

Pregnant women who have had a second-trimester pregnancy loss or an early birth linked to a weak cervix, or who have a short cervix seen on ultrasound. It may also be considered in some twin pregnancies.

Symptoms

Common symptoms

• Cervical insufficiency often has no symptoms at all.
• Pelvic pressure or a feeling of heaviness
• Lower backache
• Mild cramping
• A change in vaginal discharge
• Light vaginal bleeding or spotting

Symptoms in children

• Not applicable — cervical cerclage is only used during pregnancy.

Symptoms in older adults

• Not applicable — cervical cerclage is only used during pregnancy.

Causes

Main causes

• A weak or short cervix that opens early without labour pains — this is called cervical insufficiency.
• Previous surgery on the cervix, such as a cone biopsy or a procedure to remove abnormal cells.
• Sometimes no clear cause is found.

Risk factors

• A previous second-trimester pregnancy loss
• A previous preterm birth
• Previous cervical surgery
• Being pregnant with twins or more
• A uterus with an unusual shape
• Smoking or using recreational drugs during pregnancy

When to see a doctor

See a doctor urgently if:

• New discharge, pressure, cramps, or bleeding
• Fever or feeling unwell
• Pain at the stitch site

Book a routine appointment if:

• Before pregnancy, if you have had cervical surgery or an early birth
• Early in pregnancy, if you have had a second-trimester loss
• If you have questions about whether a cerclage is right for you

Diagnosis

Your doctor will ask about your pregnancy history and may examine you. They often use a transvaginal ultrasound — a scan probe placed gently in the vagina — to measure how long and closed your cervix is.

Tests that may be done

• Transvaginal ultrasound to measure cervical length
• Pelvic exam to look at the cervix
• Vaginal swab to check for infection
• Urine test to rule out a urinary infection

What to expect at your appointment

You may be referred to an obstetrician or fetal medicine specialist. They will explain the possible benefits and risks of a cerclage and help you decide what is best for you.

Treatment

The main treatment is cervical cerclage: a stitch placed around the cervix to help keep it closed. It is usually done between 12 and 24 weeks of pregnancy. The stitch is removed around 36 to 37 weeks, or earlier if labour starts.

Self-care at home

• Follow your maternity team's advice about activity and pelvic rest.
• Keep all your antenatal appointments.
• Watch for signs of infection or early labour.
• Ask questions if you are unsure about anything.
• Do not smoke or use recreational drugs.

Medical treatments

Your care team may also discuss other options, such as a cervical pessary (a soft ring device) or medicine to support the pregnancy, depending on your situation. They will explain what is suitable for you. Always ask your healthcare provider before starting or stopping any treatment.

When is surgery considered?

A cerclage is put in place in an operating theatre. You will usually have a spinal anaesthetic (numbing from the waist down) or a general anaesthetic (being asleep). It can be planned or done urgently if the cervix has started to open. Your team will discuss the timing and risks with you.

Living with this condition

Most women go home the same day or the next day. You may have some light spotting or mild cramping for a short time. Follow your team's advice about work, driving, and pelvic rest.

Lifestyle tips

• Avoid smoking and secondhand smoke.
• Eat a balanced diet.
• Attend all antenatal appointments.
• Ask your team before travel or strenuous activity.
• Get plenty of rest if you feel tired.

Diet and exercise

Eat a healthy mix of fruit, vegetables, whole grains, and protein. Gentle activity such as walking is usually fine if your team agrees. Avoid heavy lifting or intense exercise if you have been advised to.

Mental health and emotional wellbeing

It is normal to feel anxious or worried after a cerclage. Talk to your maternity team, a counsellor, or trusted friends and family. If you feel overwhelmed or have thoughts of harming yourself, contact your local emergency number or a crisis support service right away.

Prevention

Not every case can be prevented. If you have risk factors, early antenatal care and cervical length scans can help your team decide whether a cerclage or other support is right for you.

Vaccines

There is no vaccine for cervical insufficiency. Keep up to date with routine vaccines recommended during pregnancy by your healthcare team.

Screening programmes

Screening is not offered to everyone. Women with a history of early birth, second-trimester loss, or cervical surgery may be offered ultrasound scans to check cervical length.

Complications

If left untreated

• Preterm birth before 37 weeks
• Pregnancy loss, especially in the second trimester
• Infection
• Rupture of the membranes before labour starts

Long-term outlook

With careful monitoring and treatment, many women with a cerclage go on to have a healthy baby. A cerclage lowers the risk for some people but does not guarantee a full-term birth. Your team will support you through each step.

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