Cerclage For Cervical Incompetence
I had a miscarriage at 17 weeks. My doctor told me that I had an incompetent cervix and said I'd require a cerclage if I conceived. Can you explain the procedure?Question:
Symptoms and signs of an incompetent cervix involve painless cervical dilatation without labor in the second trimester or early third trimester. The amniotic membranes balloon into the vagina, followed by rupture of the membranes and loss of the fetus.
If the diagnosis is correct, it is highly likely that this will occur again unless treatment is initiated in the subsequent pregnancies. We don't know precisely why this occurs, but sometimes it can be linked to trauma to the cervix, especially with D&Cs, cervical conization and cautery.
Reinforcement of the weak cervix is done by some type of purse-string suture. Cerclage should generally be delayed until after 14 weeks or so so that early miscarriages may happen if they were inevitable. The later in the pregnancy this is done, the more likely it is that preterm labor and preterm rupture of the membranes will complicate the procedure. It is rare to do the suture after 24 to 26 weeks.
A sonogram is done first and then cultures for all sexually transmitted diseases and beta strep are performed.
Although it is day surgery, usually women are encouraged to rest for a few days after the procedure and to abstain from intercourse for about one week.
Infection is a possible complication, especially if done after 20 weeks.
I have seen this procedure work so many times, that it is hard not to recommend it. If you have been correctly diagnosed and you have an experienced physician, I would say that the benefits probably outweigh the risks.
Editor's Note: A study in the September 2003 issue of Obstetrics & Gynecology finds that the use of cervical cerclage (a stitch in the opening of the cervix to keep it closed) is not effective in preventing preterm birth or miscarriage in women at moderate risk of preterm birth or second-trimester pregnancy loss.