A cervical cerclage is a medical procedure used to support the cervix during pregnancy. It aims to prevent premature birth in individuals whose cervix might otherwise open too early. This article explores whether cervical dilation can still occur with a cerclage in place and outlines important considerations surrounding this procedure.
Understanding Cervical Cerclage
Cervical cerclage is a surgical procedure where a stitch or band is placed around the cervix, the lower part of the uterus, to reinforce it and help keep it closed. This procedure is typically performed to prevent preterm birth in individuals diagnosed with cervical insufficiency, a condition where the cervix painlessly shortens and dilates before the pregnancy reaches full term. The procedure is often done between 12 and 24 weeks of pregnancy, with the stitch usually remaining in place until around 36 to 37 weeks.
The Possibility of Dilation with a Cerclage
While a cerclage is designed to provide support and reduce the risk of premature cervical changes, it does not guarantee that dilation will not occur. The procedure is highly effective in 85% to 90% of cases, but dilation can still occur. Strong uterine contractions, particularly during preterm labor, can exert significant pressure on the cervix and the cerclage. This pressure may overcome the stitch’s reinforcement, leading to effacement or dilation.
Infection within the uterus or cervix can also weaken cervical tissues and contribute to premature labor, potentially impacting the cerclage’s effectiveness. Preterm premature rupture of membranes (PPROM), or the water breaking early, can precede or induce labor, which then places immense stress on the cerclage. In some instances, the cerclage stitch itself might loosen, slip, or even break. If the cervix had already undergone significant shortening or dilation before the cerclage was placed, the risk of further changes may remain higher.
Recognizing Potential Issues
Individuals with a cerclage should monitor for specific symptoms that may indicate cervical changes or problems with the stitch:
- Increased vaginal discharge (watery, bloody, or unusual odor).
- Pelvic pressure or pain.
- Abdominal cramping or contractions.
- Persistent backache.
- A feeling of something “falling out” from the vagina.
- Vaginal bleeding, even if light.
These symptoms do not necessarily mean the cerclage has failed, but they require prompt medical evaluation to assess the cervical status and the integrity of the cerclage.
Managing Concerns and Next Steps
If an individual experiences symptoms that suggest potential issues with their cerclage or cervical changes, immediate medical evaluation is necessary. Healthcare providers perform a physical examination and an ultrasound to assess cervical length and the cerclage’s position. This evaluation helps determine if the cervix is shortening or dilating despite the stitch.
Depending on the findings, various medical interventions may be considered. Interventions may include:
- Bed rest.
- Medications to stop contractions.
- Antibiotics if an infection is suspected.
- Steroids to aid in fetal lung development if preterm birth is a concern.
In certain severe circumstances, such as active labor or significant infection, emergency cerclage removal might be necessary. Following medical advice closely, attending all scheduled appointments, and maintaining open communication with the healthcare team are important steps in managing these situations.
Cerclage Removal and Delivery
A cervical cerclage is typically removed between 36 and 37 weeks of pregnancy, a time when the risk of preterm birth significantly decreases. The removal procedure is quick, taking only a few minutes, and is often performed in an outpatient setting, such as a doctor’s office. Many individuals find the removal procedure causes minimal discomfort and does not require anesthesia.
After the cerclage is removed, labor may begin naturally within days or weeks. In some cases, a labor induction might be planned. While most transvaginal cerclages are removed to allow for vaginal delivery, a cerclage can be removed earlier if medically necessary, such as in cases of active labor or infection. In rare instances, the stitch may be left in place, necessitating a Cesarean section for delivery.