Cervical Cerclage (Insertion and Removal)

Abstract

Cervical cerclage involves the placement of a circumferential suture at various anatomical sites along the length of the cervix to prevent pregnancy loss in women with cervical insufficiency. The procedure can be indicated by history, ultrasound imaging or physical examination. Contraindications include multiple pregnancy, chorioamnionitis, ongoing vaginal bleeding pre-term premature rupture of membranes and active labour. The different suturing techniques include transvaginal, high transvaginal, transabdominal and occlusion cerclage. It is commonly performed as a day case procedure under spinal or general anesthesia. Avoidance of general anesthesia is preferred by some practitioners due to the potential risks of fetal exposure to anesthetic medications and, for the mother, of failed intubation and pulmonary aspiration. General anesthesia may, however, facilitate earlier discharge, improve surgical access, and reduce the risk of ruptured membranes in certain cases. Complications of cerclage include rupture of fetal membranes, pre-term labour, bleeding, and infection.