Uterine cerclage is a surgery indicated to prevent premature birth in women who have cervical insufficiency, which is a dilation that can begin in the first or second trimester of pregnancy.
This surgery, also called cerclage of the cervix or cervical cerclage, is performed by the obstetrician in the hospital, transvaginally and, in some cases, by laparoscopy, and can be performed urgently or on a scheduled basis by the obstetrician.
Uterine cerclage can be offered free of charge by the SUS and recovery is quick but requires some care, such as avoiding exertion in the first few days or intimate contact in the first few weeks, as advised by the obstetrician.
When is indicated
Uterine cerclage surgery is indicated for:
- Insufficiency of the cervixin order to prevent the risk of premature birth or miscarriage;
- History of one or more pregnancy losses in the second trimester related to painless cervical dilation or placental abruption;
- History of uterine cerclage due to painless dilation of the cervix in the second trimester;
- Short cervixless than 25 millimeters, before 24 weeks of pregnancy;
- History of spontaneous loss or premature birth less than 34 weeks of gestation, due to the short cervix;
- Dilation of the cervix during the second trimester of pregnancy.
Furthermore, emergency uterine cerclage may be indicated by the obstetrician in the case of advanced dilation of the cervix, in pregnancy less than 24 weeks, and in the absence of contractions, intra-amniotic infection or placental abruption.
When can surgery be done?
Generally, uterine cerclage is recommended to be carried out between 12 and 14 weeks of gestation, but it can also be carried out up to 23 weeks, if the gynecological examination or ultrasound shows insufficiency of the uterine cervix. Understand better what cervical insufficiency is.
Cerclage can only be performed during pregnancy and is not recommended for women who have not yet become pregnant, even if they have had previous miscarriages.
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How to prepare for surgery
Uterine cerclage surgery can be performed as an emergency, but it can also be scheduled by the obstetrician.
In this case, some precautions are important to prepare for surgery, such as:
- Clarify all your doubts about the surgery with your doctorrecovery and risks for the woman and baby;
- Avoid sexual contact for about 1 week before surgeryor as directed by the doctor;
- Have an ultrasound to check the baby’s vital signssuch as heartbeat, in addition to evaluating whether the fetus has any malformations.
Another test that the doctor can perform is other tests, such as evaluating cervical secretions and amniocentesis, to identify infections. Find out how amniocentesis is performed.
How is the surgery done
Uterine cerclage surgery is simple, lasts about 20 minutes, and consists of sewing the cervix together with a few stitches, which are then removed at the 37th week of pregnancy.
This surgery is performed in the hospital, with hospitalization, and before starting the surgery, saline solution is administered into the vein, by the nurse, to hydrate and administer medication, if necessary.
Uterine cerclage is performed with epidural anesthesia and is generally performed transvaginally, however, in some cases, the doctor may decide to perform it laparoscopically. See how laparoscopy and recovery is performed.
What is recovery like?
Recovery after uterine cerclage surgery takes place in the hospital for the first 1 to 2 days, under the supervision of an obstetrician, an anesthesiologist and a nurse. During this period, the doctor may prescribe analgesics for pain and medicines such as Utrogestan, to prevent uterine contractions.
Furthermore, right after the surgery, the doctor may perform an ultrasound to check how the stitches are and to assess whether the baby is well.
The woman should rest and avoid intimate contact in the first few weeks. Furthermore, it is also not recommended to exercise, lift weights or make great efforts, at least in the first 3 days after surgery.
What does childbirth look like after cerclage?
Generally, the cerclage is removed around 37 weeks of pregnancy, however if the birth is performed by cesarean section, it is not necessary to remove the cerclage, as it may be useful in the next pregnancy.
The decision on the type of birth must be discussed between the woman and the doctor, observing the indications, advantages and disadvantages of each one. Check out the differences between normal birth and cesarean section and when they are indicated.
Possible complications
The main complications of uterine cerclage surgery are uterine infection, inflammation of the fetal membranes, vaginal bleeding, laceration of the cervix or premature rupture of the membranes.
Furthermore, although rare, complications of epidural anesthesia may occur, such as a drop in blood pressure, chills, tremors, nausea, vomiting, fever, infection, damage to the nerve near the site or epidural bleeding, for example.
Warning signs to go back to the doctor
It is important to consult an obstetrician or go to the nearest emergency room if symptoms such as:
- Fever;
- Severe abdominal pain;
- Cramps;
- Vaginal bleeding;
- Bad-smelling discharge.
These symptoms may indicate an infection and, in these cases, medical help should be sought immediately, as the infection can put the life of the mother and baby at risk.
