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Pregnancy and Childbirth: Abdominal Cerclage

Your doctor suggests that you have cerclage. This procedure closes the cervix during a pregnancy. It is done to help prevent miscarriage or premature birth. Abdominal cerclage involves making one or more incisions in the abdomen to reach the cervix. The cervix is then stitched closed. Read on to learn more.

Cross section side view of woman's pelvis showing baby developing in uterus. Band is around cervix to hold it closed.

The Cervix and Pregnancy

The uterus (womb) is where the baby grows during pregnancy. The cervix is the opening from the uterus to the vagina. The cervix normally remains firmly closed until the baby is ready to be born. A short or weakened cervix may not be able to stay closed as the baby grows larger. This is called cervical insufficiency or cervical incompetence. If the cervix fails and opens too soon, miscarriage or premature birth may result.

How Abdominal Cerclage Works

The goal of cerclage is to hold the cervix closed. This allows the baby to fully develop before leaving the womb. Abdominal cerclage is done when other procedures to close the cervix have failed. It is done at about week 12 of pregnancy. The doctor reaches the cervix through the abdomen. The cervix is then stitched closed. Following the procedure, you must give birth by cesarean. Future births will also need to be cesarean.

Risks and Possible Complications of Abdominal Cerclage

The procedure is considered safe. But like all procedures, it carries some risks. These include the following:

  • Bleeding

  • Infection

  • Premature contractions

  • Premature labor or delivery

  • Premature rupture of membranes

  • Pregnancy loss

  • Tearing or rupture of the cervix

  • Injury to bladder or other nearby organs

  • Risks of anesthesia 

Preparing for the Procedure

  • Tell your doctor about all medications you take. This includes over-the-counter medications like vitamins and pain medications.

  • Do not put anything in your vagina for 24 hours before the procedure. This includes having intercourse.

  • If instructed, do not eat or drink anything (including water) after the midnight the night before the procedure. (If you have diabetes, ask your health care provider whether you need special preparations.)

The Day of the Procedure

  • Just before the procedure begins, an intravenous (IV) line is placed in your hand or arm. It delivers fluids and medication into the body.

  • You will be given medication (anesthesia) to keep you free of pain during the procedure. Depending on what type of anesthesia you get, you may be relaxed, drowsy, or fully asleep during the procedure.

  • The surgery may be done using either open surgery or laparoscopy.

    • For open surgery, one larger incision is made in the abdomen. The doctor sees and works through this incision. 

    • For laparoscopy, the doctor makes 2 to 4 small incisions in the abdomen. A thin lighted tube called a laparoscope is then used. The scope allows the doctor to work through the small incisions. The scope is put through one of the incisions. The scope sends pictures of the abdomen to a video screen. This allows the doctor to see inside the abdomen. Surgical tools are placed through the other small incisions.The abdomen is filled with carbon dioxide. This gas makes space for the doctor to see and work. 

  • For either technique:

    • Surgical tools are used to release (cut) the tissue that connects the bladder and the lower part of the uterus, including the cervix. This gives access to the cervix.

    • A special surgical tape is wrapped around the cervix. The tape is tied in a knot.

    • The incision is closed with stitches (sutures) or staples. A tube may be placed in the incision to drain fluids, and then be removed.

After the Procedure

  • You will be taken to a room where you’ll recover from the anesthesia. Nurses will check on you as you rest.

  • You will be watched for signs of premature labor. You will also be given medication that helps prevent premature labor.

  • Your baby’s heart rate will be monitored.

  • You will have some light bleeding and cramping. This is normal. You will likely be given pain medication. If you are still in pain, tell the nurse.

  • You may be able to go home later that day. Or you may stay overnight in a hospital room to be sure you do not go into premature labor. When you leave the hospital, have an adult friend or family member drive you home.

Recovering at Home

  • You will probably be prescribed pain medication to take at home. You may also be prescribed medication to prevent labor. Take any medication as prescribed.

  • Take it easy for 4 days to 5 days after the procedure. Plan to have others help you as needed. If instructed to do so, you will need to stay in bed. Otherwise, you can get out of bed and do light activities.

  • You will need to avoid intercourse until told you can resume by the doctor. This will likely not be until 2 weeks to 6 weeks after the procedure.

  • Ask your doctor when you can return to work and exercise.

  • Care for your incision as instructed by your doctor. You will have a dressing (bandage). Be sure you have instructions for when and how to change the dressing. Also be sure you know whether you can get the incision wet when you bathe. If you have a drain that was not removed in the hospital, be sure you know how to care for it at home.

When to Call the Doctor

Call your doctor if you notice any of the following: 

  • A fever of 100.4°F (38°C) or higher

  • Pain that does not go away even after taking pain medication

  • Contractions or abdominal cramping

  • Unexpected vaginal spotting or bleeding

  • Fluid leaking from the vagina

  • Bleeding from the vagina

  • Foul-smelling drainage from the vagina

  • Back or abdominal pain

  • Signs of infection at the incision site or sites, such as redness or swelling, warmth, worsening pain, or foul-smelling drainage.

Follow-Up

Make a follow-up appointment as directed by our staff. During your follow-up visit, your doctor will check your healing. You can also discuss how your pregnancy is progressing. 

 

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