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Cervical Cerclage
Description
Cervical cerclage is the placement of a suture or tape to support and partially occlude the uterine cervix to reduce the risk for preterm delivery in the face of cervical insufficiency. A number of procedures have been described, but the most common and simplest is the McDonald cerclage, which is described here. Cervical cerclage also may be accomplished by placing the suture via an abdominal route, although this is a much more invasive procedure and the suture is generally left in place permanently, precluding vaginal delivery.
Indications
Cervical incompetence as documented by a history of preterm pregnancy loss associated with painless cervical dilation or prolapse and ballooning of the fetal membranes into the vagina without labor. Cerclage may be placed based on history or cervical shortening documented through ultrasonography. Prophylactic cervical cerclage is generally delayed until after 14 weeks so that early pregnancy losses from other factors may be resolved. Cerclage is not performed after 26–28 weeks gestation.
Contraindications
Bleeding, uterine contractions, obvious infection, multiple gestation, fetal demise, or rupture of the membranes. Beyond 24–26 weeks, bed rest, pessary therapy, or other treatments are often preferred because of the increased risk for surgically related labor.
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