When It Is Needed, Procedure, Risks & Pregnancy Care for Cervical Cerclage
When It Is Needed, Procedure, Risks & Pregnancy Care for Cervical Cerclage
A cervical cerclage, also called a cervical stitch, is a procedure in which a strong suture is placed around the cervix to help keep it closed during pregnancy.
It may be recommended for women who have a higher risk of second-trimester pregnancy loss or spontaneous preterm birth because the cervix may shorten or open too early.
A cervical stitch is not required in every woman with a short cervix. The decision depends on factors such as your previous pregnancy history, cervical length, whether the cervix has started to open, gestational age, whether you are carrying one or more babies, and other pregnancy findings.
In many cases, a planned cervical cerclage is placed during the second trimester and removed near the end of pregnancy.
Cervical cerclage is a procedure used to help keep the cervix closed during pregnancy.
The cervix is the lower part of the uterus that opens into the vagina. During a normal pregnancy, it generally remains closed and provides support to the developing pregnancy.
In some pregnancies, the cervix may shorten or open earlier than expected without normal labour. This is commonly referred to as cervical insufficiency.
A cervical stitch provides mechanical support around the cervix.
It is important to understand that cervical cerclage does not treat every cause of preterm birth. Preterm birth can occur for many different reasons, including infection, premature rupture of membranes, placental problems, spontaneous labour and other complications.
Cervical insufficiency is a clinical condition in which the cervix begins to shorten and/or open prematurely, often in the second trimester, without the typical symptoms of labour.
The older term “cervical incompetence” is still commonly used by patients, but healthcare professionals increasingly use the term cervical insufficiency.
It is important not to assume that every woman with a short cervix has cervical insufficiency.
Cervical length is only one part of the assessment. Your pregnancy history, examination findings, gestational age and other risk factors are also important.
There is not always one identifiable cause.
Factors that may be associated with cervical insufficiency or an increased risk of cervical shortening or early cervical opening include:
Previous second-trimester pregnancy loss
Previous spontaneous preterm birth
Previous cervical cerclage
Previous procedures on the cervix, such as some excisional procedures
Cervical injury or trauma
Certain congenital or structural differences of the uterus or cervix
Previous cervical dilation in certain circumstances
However, many women with cervical shortening or cervical insufficiency have no obvious cause.
Having cervical insufficiency is not something you should blame yourself for.
One of the important features of cervical insufficiency is that it may occur with few or no obvious symptoms.
Possible symptoms can include:
Pelvic pressure
A feeling of heaviness in the pelvis
Lower abdominal discomfort
Backache
Increased vaginal discharge
Vaginal spotting or bleeding
Mild cramping
Feeling that something is “coming down”
However, these symptoms are not specific to cervical insufficiency and can occur for many other reasons during pregnancy.
Some women may have cervical shortening or opening discovered during an ultrasound or examination before they notice any symptoms.
Therefore, if you have risk factors for cervical insufficiency, your obstetrician may recommend cervical-length monitoring even if you feel completely well.
Yes. Cervical insufficiency can contribute to pregnancy loss, particularly in the second trimester.
If the cervix opens prematurely, the membranes may bulge through the cervix, the waters may rupture, or infection and pregnancy loss may occur.
However, second-trimester miscarriage has many possible causes. A cervical stitch is therefore not appropriate for every woman who has experienced a miscarriage.
Your doctor will consider the pattern and timing of any previous pregnancy loss when assessing your risk.
Cervical insufficiency can increase the risk of spontaneous preterm birth.
When the cervix shortens or opens prematurely, the pregnancy may be at increased risk of progressing to preterm birth.
However, cervical insufficiency is only one of many causes and risk factors for preterm birth.
This is why prevention strategies are individualized rather than giving every pregnant woman a cervical stitch.
There is no single test that diagnoses cervical insufficiency in every woman.
Assessment may include:
Your doctor may ask about:
Previous second-trimester losses
Previous spontaneous preterm births
Previous cervical cerclage
Previous cervical procedures
Previous pregnancy complications
A previous pregnancy ending early because of painless cervical dilation can be particularly relevant.
A transvaginal ultrasound is commonly used to measure cervical length when cervical-length assessment is indicated.
Transvaginal ultrasound is the preferred method when cervical length is being used to guide clinical decisions.
If cervical opening is suspected, your doctor may examine the cervix to determine whether it has begun to dilate.
The appropriate assessment depends on your symptoms and pregnancy history.
No. They are related but not exactly the same thing.
A short cervix means that the cervix measures shorter than expected for that stage of pregnancy.
Cervical insufficiency generally refers to premature cervical shortening and/or opening in a clinical context suggesting that the cervix may not be able to maintain the pregnancy to term.
A woman can have a short cervix without having classic cervical insufficiency.
This distinction matters because not every woman with a short cervix needs a cervical stitch.
For example, in women with a singleton pregnancy and no previous spontaneous preterm birth, SMFM recommends vaginal progesterone for certain short-cervix measurements and recommends against cerclage when there is a short cervix without cervical dilation.
A cervical stitch may be considered in different clinical situations.
A planned cerclage may be offered to women whose previous pregnancy history suggests a significant risk of recurrent second-trimester loss or spontaneous preterm birth related to cervical insufficiency.
The timing and exact criteria vary according to the clinical guidelines and the individual patient's history.
A cervical stitch may be considered when cervical shortening is identified on transvaginal ultrasound in a woman with an appropriate risk profile.
The decision depends on factors such as:
Cervical length
Gestational age
Previous spontaneous preterm birth
Whether the cervix is dilated
Singleton or multiple pregnancy
Other pregnancy findings
In selected cases, the cervix may already have begun to open during the second trimester.
An emergency or physical-examination-indicated cerclage may sometimes be considered when the membranes are intact and there are no contraindications.
This type of cerclage has greater risks and is less likely to be successful than a planned cerclage.
A planned cervical stitch is generally placed during early or mid-pregnancy, commonly between approximately 12 and 24 weeks, depending on the indication.
The exact timing depends on why the cerclage is being recommended.
For example, a woman with a strong history suggesting cervical insufficiency may be offered a planned stitch earlier, while an ultrasound-indicated stitch may be considered after cervical shortening is identified.
An emergency stitch may be considered later in selected situations.
Your obstetrician will determine the appropriate timing based on your individual pregnancy.
A common type of cerclage is a transvaginal cervical stitch.
The general process is:
You are admitted or attend the hospital for the procedure.
The procedure is performed under an appropriate form of anaesthesia.
A speculum is used to access the cervix through the vagina.
A strong suture is placed around the cervix.
The stitch is tightened to provide support around the cervix.
You are monitored after the procedure before going home or continuing your hospital care.
The exact surgical technique and type of anaesthesia can vary.
A transvaginal cerclage is placed through the vagina around the cervix.
It is the more commonly used type of cervical stitch.
A transvaginal stitch is usually removed near the end of pregnancy, generally around 36–37 weeks, unless labour or another clinical situation requires earlier removal.
A transabdominal cerclage is a less common type of cervical stitch placed higher around the cervix through surgery involving the abdomen.
It may be considered for selected women, particularly when a vaginal cerclage has not been successful in a previous pregnancy or when a vaginal stitch cannot be placed effectively.
A transabdominal cerclage is usually placed before pregnancy or during early pregnancy in appropriate cases.
Unlike a routine vaginal stitch, an abdominal cerclage is generally not removed during pregnancy, so delivery is by caesarean birth.
The cerclage procedure itself is performed under anaesthesia, so you should not feel the procedure in the usual way.
Afterwards, you may experience:
Mild cramping
Pelvic discomfort
Mild vaginal bleeding or spotting
Brownish vaginal discharge
The amount of discomfort varies between women.
Your doctor will advise you about appropriate pain relief and what symptoms are expected after the procedure.
Some women experience mild cramping or spotting for a short period after the procedure.
Your healthcare team may advise you to take it easy immediately after the procedure while you recover.
However, routine prolonged bed rest is not generally recommended solely because you have a cervical stitch.
Your individual doctor may provide specific instructions regarding physical activity, sexual activity, work and follow-up depending on why the cerclage was placed and how your pregnancy is progressing.
You should contact your maternity care team promptly if you develop:
Regular contractions
Increasing abdominal or pelvic pain
Heavy or persistent vaginal bleeding
Leakage of fluid from the vagina
Foul-smelling or green vaginal discharge
Fever or other signs of infection
Like any surgical procedure, cervical cerclage has potential risks.
These may include:
Bleeding
Infection
Injury to the cervix
Injury to nearby structures such as the bladder
Premature rupture of membranes
Contractions or pregnancy complications
Failure of the stitch to prevent miscarriage or preterm birth
The risks may be different for a planned versus emergency cerclage.
An emergency cerclage, particularly when the cervix is already significantly dilated, can carry greater risks and has a lower likelihood of success.
Your doctor should discuss the potential benefits and risks before the procedure.
Yes. A cervical stitch cannot guarantee that miscarriage or preterm birth will be prevented.
Even when the stitch is placed successfully, some women may still experience:
Cervical shortening or opening
Contractions and preterm labour
Premature rupture of membranes
Infection
Pregnancy loss
Preterm birth
The success of cerclage depends on why it was placed, when it was placed, the condition of the cervix, and other pregnancy factors.
A cerclage is therefore a risk-reduction treatment, not a guarantee of carrying the pregnancy to term.
A cervical stitch is placed around the cervix, not around the baby.
A properly performed cerclage is intended to support the cervix and does not directly interfere with the baby's growth or development.
RCOG patient guidance states that a cervical stitch does not affect the baby's growth and development.
However, cerclage is a surgical procedure and has potential maternal and pregnancy-related complications. This is why it is recommended only when the expected benefits justify the risks.
A routine vaginal cervical stitch is generally removed at around 36–37 weeks of pregnancy.
It may need to be removed earlier if:
Labour begins
The waters break
There is another clinical reason requiring removal
If labour begins while a vaginal stitch is still in place, the stitch should be removed promptly to reduce the risk of cervical injury.
If you are having a planned caesarean birth, your doctor may remove the vaginal stitch at the time of the caesarean.
An abdominal cerclage is different and is generally left in place, with delivery by caesarean birth.
If you have a vaginal cervical stitch and develop signs of labour, contact your maternity unit immediately.
The stitch generally needs to be removed if labour has started because continued tightening of the cervix against the stitch can cause cervical injury.
Similarly, if your waters break before labour, your healthcare team will assess the situation and decide whether and when the stitch should be removed, taking infection and other risks into account.
Having a cervical cerclage does not usually prevent you from becoming pregnant in the future.
However, the reason you needed the cerclage may affect how your next pregnancy is managed.
For example, if you had a previous pregnancy affected by cervical insufficiency or spontaneous preterm birth, your doctor may plan:
Earlier specialist review
Cervical-length monitoring
Preventive treatment where appropriate
Another cervical stitch if indicated
A previous successful cerclage does not automatically mean that every future pregnancy will require one, but your obstetrician will review your previous pregnancy history.
Cervical insufficiency is not usually described as something that can be permanently “cured.”
Instead, doctors focus on reducing the risk of pregnancy loss or spontaneous preterm birth in future pregnancies.
Depending on your history, management may include:
Cervical-length monitoring
Vaginal progesterone in appropriate situations
Cervical cerclage when indicated
Close antenatal monitoring
Management of other risk factors
The appropriate approach varies from pregnancy to pregnancy.
There is no guaranteed way to prevent cervical insufficiency.
However, if you have a history that places you at increased risk, early antenatal care allows your doctor to create a prevention and monitoring plan.
This may include:
Reviewing previous pregnancy outcomes
Identifying previous cervical procedures
Monitoring cervical length when indicated
Considering progesterone where appropriate
Considering cerclage when clinically indicated
Importantly, routine bed rest is not recommended as a general method of preventing preterm birth.
Cervical-length assessment is particularly relevant in women who have risk factors for spontaneous preterm birth or cervical insufficiency.
A transvaginal ultrasound can measure cervical length during the mid-trimester.
Your doctor may recommend monitoring based on:
Previous spontaneous preterm birth
Previous second-trimester pregnancy loss
Previous cervical cerclage
Previous cervical procedures
Current cervical findings
Other pregnancy-related risk factors
Not every pregnant woman requires repeated cervical-length measurements, so screening should be individualized according to clinical guidance and your pregnancy history.
There is no universal list of activities that every woman with a cervical stitch must avoid.
Your doctor may provide temporary restrictions immediately after the procedure, depending on your individual circumstances.
In general:
Follow your obstetrician's post-procedure instructions.
Attend recommended follow-up appointments.
Do not ignore contractions, bleeding or fluid leakage.
Do not start medications or supplements without medical advice.
Do not assume that bed rest is necessary unless specifically advised for another medical reason.
RCOG guidance states that routine bed rest is not recommended after a cervical stitch.
Cerclage is not appropriate in every situation.
A stitch may not be recommended when there are factors suggesting that it would not improve the outcome or could increase risk.
For example, RCOG advises that cerclage may not be appropriate when there are signs of:
Infection
Active vaginal bleeding
Uterine contractions
Ruptured membranes
The decision is individualized, particularly in an emergency situation.
Cervical Cerclage: The Key Takeaway
A cervical stitch can be an important treatment for selected women at increased risk of second-trimester pregnancy loss or spontaneous preterm birth.
However, having a short cervix does not automatically mean that you need cerclage.
Your doctor considers your:
Previous pregnancy history
Cervical length
Gestational age
Whether the cervix is already dilated
Singleton or multiple pregnancy
Previous cervical procedures
Symptoms and examination findings
Other pregnancy-related factors
A cervical stitch can reduce risk in appropriate patients, but it cannot guarantee that miscarriage or preterm birth will be prevented.
If you have been told that your cervix is short, or you have had a previous second-trimester loss or spontaneous preterm birth, early consultation with an obstetrician can help determine whether cervical-length monitoring, progesterone, cerclage or another approach is appropriate for your pregnancy.