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Approximately 10% of pregnancies nowadays ends in premature delivery. There is 3.3 times more possibility for a pregnant woman to undergo premature labor if she has an incompetent cervix (Source) A narrow neck-like passage that forms the uterus’s lower part and extends to the vagina is called the cervix. If a pregnant woman’s cervix is weak, it starts to widen and thins out before the pregnancy reaches full term, unlike the dilation and effacement that occurs in response to uterine contractions in a normal pregnancy. Therefore, a weak cervix can cause pregnancy loss or can lead to preterm birth. Cervical cerclage is the procedure that helps to prevent the consequences due to cervical weakness. Here is all that you need to know about this procedure.
A weakened or incompetent cervix can be caused by any of the following conditions:
It is a small surgical procedure in which a suture is placed around the incompetent cervix during pregnancy to prevent it from opening due to any pressure as the pregnancy progresses. Most often, the women who need a cervical cerclage in one pregnancy will require it in successive pregnancies.
There are basically 3 types of cervical cerclage. These are:
Usually, cervical weakness will be detected during the routine tests conducted in the first trimester itself. The most appropriate time for the cervical cerclage procedure is during the 3rd month, usually between the 12th and 14th weeks of gestation (elective cerclage). There may be cases where some pregnant women may develop cervical weakness during later stages of pregnancy. They will require a cervical cerclage which is known as an emergent cerclage and the procedure is performed after the cervix has already started to open up.
The doctor administers general, spinal or epidural anesthesia to the pregnant women to manage the pain during the procedure. The doctor will stitch a band consisting of strong thread around the cervix. This thread will be tightened to firmly close and hold the cervix together.
Generally, the cervical cerclage is removed at the 37th week of pregnancy. But it can be removed earlier if the water breaks or if the pregnant woman experiences contractions.
Unfortunately, cervical cerclage is not a hundred percent risk-free procedure. Cervical cerclage can set forth a chain of issues that could end in spontaneous abortion or premature labor.
Cervical cerclage is a life-saving procedure. Therefore, the necessity outweighs the possible risks involved in this procedure. After the cervical cerclage, about 1-9 % of pregnant women are found to undergo premature delivery. Here are 8 possible risks associated with cervical cerclage:
In addition to the above risks, all the risk that associated with local or general anesthesia is relevant to this surgical procedure too.
A cerclage is considered successful if the patient could able to hold the pregnancy for a full term, that is, for 37 weeks. The success rate of this procedure is about 80–90% in case of elective cerclage, and the success rate is about 40–60% for emergent cerclage (Source)
Usually, bed rest is the most appropriate alternative to cervical cerclage. It is usually advised to those pregnant women in whom the changes in the cervix are found very late in pregnancy or in cases where cervix has already opened up significantly.
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