Cervical cerclage is a procedure in which a stitch is placed around the mouth of the womb (cervix) to help keep it closed and enable a pregnancy to go to term in women with a history suggestive of cervical insufficiency.
Cervical insufficiency is suspected in women that have previously suffered recurrent pregnancy losses in the middle trimester of pregnancy (14 to 26 weeks) that are associated with painless cervical dilatation without evidence of uterine contractions. Cervical cerclage may help prevent miscarriage or preterm birth caused by cervical insufficiency.
The stitch is usually placed vaginally, but sometimes requires to be placed through the abdomen. Transabdominal cerclage (TAC) is an uncommon procedure but may be recommended in the following situations:
- a vaginal cervical stitch has not worked in the past
- it is not possible to insert a vaginal stitch due to previous severe trauma of the cervix ie- amputated or severely shortened or injured cervix following a difficult previous child birth or cone biopsy
TAC allows the stitch to be inserted at a position higher up the uterus than through the vagina.
TAC is done either before a woman becomes pregnant or in early pregnancy. Evidence does not show a difference in fertility and successful pregnancy rate between women who had a cerclage placed before pregnancy or after they are pregnant. However insertion before pregnancy may be associated with lower blood loss during the operation.
TAC may be done through a cut on your abdomen or via keyhole surgery (Laparoscopy). This sort of stitch is not removed and your baby would need to be born by caesarean section. You will need another surgery after your family is complete to remove the abdominal cervical stitch which may be done at the time of your last caesarean section.
Benefits of laparoscopic (key hole surgery) surgery compared to open surgery:
- Less blood loss,
- Less postoperative pain
- Less fever and adhesions
- Better cosmetic results
- Reduced hospital stay
Expected success rate of Transabdominal Cervical Cerclage: Success rates in different studies to achieve pregnancy duration of greater than 34 weeks have been over 80% (Moawad et al, Systematic Review of Transabdominal Cerclage Placed via Laparoscopy for the Prevention of Preterm Birth, Journal of Minimally Invasive Gynaecology, 2017).
Our team at Borrowdale Fertility and Reproductive Endocrinology Clinic has the training and expertise to offer all types of cerclage including Transabdominal cervical cerclage to women who may benefit from it.
