Cervical cerclage

Cervical cerclage

• cervical cerclage - also known as a cervical stitch
  • is a treatment used to prevent the cervix opening too early and causing either a late miscarriage or preterm birth
    • cerclage may be performed as a prophylactic measure where the woman has a history that increases the risk of spontaneous second-trimester loss or preterm delivery and/or cervical shortening seen on ultrasound
      
      
  • can also be performed as a salvage measure ('rescue' or non-prophylactic cerclage) when a woman presents with premature cervical dilation, often with exposed fetal membranes, and in some cases where the membranes have prolapsed into the vagina

'Rescue' cervical cerclage

• 'rescue' cervical cerclage should not be offered to women with:
  • signs of infection or
  • active vaginal bleeding or
  • uterine contractions
    
    
• consider 'rescue' cervical cerclage for women between 16+0 and 27+6 weeks of pregnancy with a dilated cervix and exposed, unruptured fetal membranes:
  • take into account gestational age (being aware that the benefits are likely to be greater for earlier gestations) and the extent of cervical dilatation
  • this decision should be after discussion between a consultant obstetrician and consultant paediatrician
    
    
• if 'rescue' cervical cerclage is used, ensure that a plan is in place for removal of the suture

Reference:

• NICE (August 2019).Preterm labour and birth