What Is a Cervical Cerclage?

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Cervical cerclage—a procedure that reinforces the cervix—helps prevent the cervix from opening too early in the pregnancy. A stitch is placed around the cervix during the procedure to prevent it from dilating and shortening. This procedure is also known as a cervical stitch.

This article discusses why a cerclage is done, whom it is for, risks, and what to expect from the procedure.

pregnant person at the doctor

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Uses

It’s normal for the cervix to begin to shorten and soften toward the end of pregnancy. The cervix softens to help your body prepare to deliver your baby. But in some cases, the cervix starts weakening too early, increasing your risk of early delivery or miscarriage.

Cervical insufficiency (sometimes called an incompetent cervix) occurs when the cervix shortens and opens earlier in your pregnancy than normal. It is usually diagnosed in the second trimester of pregnancy. This condition affects up to 1% of pregnant people.

Cervical insufficiency can lead to:

  • Membrane prolapse (when the sac filled with fluid that surrounds your baby slips through the opening of your cervix)
  • Premature membrane rupture, more commonly known as your water breaking
  • Loss of pregnancy in the second trimester
  • Preterm birth

You are at a higher risk of cervical insufficiency and may benefit from a cerclage procedure if:

  • You have a history of miscarrying in the second trimester.
  • You have had previous surgeries on your cervix.
  • You have a cervical length less than 25 millimeters early in your pregnancy (usually assessed during an ultrasound).
  • Your cervix begins dilating before 24 weeks.

For women with the risk factors for cervical insufficiency and a gradually opening cervix, your healthcare provider may recommend a cerclage procedure to help you carry to full term.

Typically, the procedure is completed before 24 weeks. For women with a history of cervical cerclages during previous pregnancies, the cerclage may be placed as early as 12 weeks.

When Is a Cervical Cerclage Not Recommended?

A cervical cerclage isn’t the best option for all women with a weakening cervix. It is not recommended for women with:

  • Preterm labor
  • Vaginal bleeding
  • Active infections in the uterus
  • Early leaking or bursting amniotic sac (also known as your water breaking)
  • A multiple pregnancy (you're pregnant with more than one baby)
  • A fetal abnormality affecting the health of your baby

Risks

As with any procedure, you and your doctor will discuss the benefits and potential risks before deciding if a cervical cerclage is right for you. Risks include:

  • Infection
  • Leaking of amniotic fluid or your water breaking
  • Abdominal or back pain
  • Spotting or vaginal bleeding
  • Cervical tear, especially if the stitch remains in place before labor begins
  • Early labor

What to Expect

The cervical cerclage is considered an outpatient procedure. You may need to stay at the hospital for a few hours to a few days depending on:

  • The type of anesthesia used
  • Placement method

Plan to relax at home for at least two or three days after the procedure and to avoid strenuous activity. Gradually, you can increase your activity again following your doctor’s recommendation.

How to Prepare

Before scheduling the procedure, your doctor will assess if you are a good candidate for it by:

  • Completing an ultrasound to confirm the gestational age
  • Assessing for any genetic conditions
  • Assessing the anatomy of your baby and their location in the womb
  • Screening for infection

Your doctor will discuss pain management and post-procedure care recommendations with you to help prepare you for the cervical stitch.

During the Procedure

The most common technique for this procedure is transvaginal, meaning they will place the stitch in the cervix through the opening of the vagina. If the transvaginal procedure fails, your doctor may consider placing the stitch through an incision in your abdomen. An abdominal cerclage may also be placed prior to pregnancy for women with certain risk factors.

A cerclage procedure is done under general or regional anesthesia to control pain. Your doctor will place a stitch around the cervix to keep it closed and supported.

After the Procedure

Your doctor will do an ultrasound after the cerclage placement to assess the cervix and check on your baby.

Some pregnant women experience cramping and light bleeding for a few days after the procedure. If you have any questions about symptoms after the procedure, contact your healthcare provider.

Depending on how far open your cervix is, you might stay a few extra days at the hospital for your healthcare team to observe the health of you and your baby.

Your doctor will give you specific recommendations for how physically active you can be and how long to wait before having sex.

After the cerclage placement, you will follow up with your doctor every one to two weeks for the rest of your pregnancy.

Cerclage Removal

The cerclage removal occurs between 36 and 38 weeks of pregnancy. If you show signs of preterm labor, the cerclage will be removed earlier to reduce potential damage to the cervix.

If you plan to deliver by a cesarean section, the cerclage removal may wait until then.

The procedure to remove the cerclage is straightforward and often completed in your healthcare provider's office. In some cases, the removal is done in the hospital.

If you had a transabdominal cerclage placed, you will likely have a cesarean section to deliver your baby. The incision for the cesarean will be right above the incision for the cerclage.

A Word From Verywell

A cervical cerclage reduces the risk of early birth in women with a history of cervical insufficiency. Not all doctors agree on the effectiveness of cerclage procedures, and it isn't the best option for everyone.

If you do need a cervical cerclage for one pregnancy, you will likely need a cerclage to help you carry future pregnancies to full term. Your healthcare provider will help you figure out if a cerclage procedure is right for you.

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