Cerklage

Cerklage, also known as cervical cerclage, is a obstetric procedure in which sutures are placed around the cervix to reinforce it and help prevent premature dilation during pregnancy. It is used for women at risk of cervical insufficiency, a condition where the cervix dilates prematurely without contractions, risking second-trimester loss or preterm birth.

Indications for cerklage include a history of painless second-trimester pregnancy losses attributed to cervical insufficiency, a very short cervix identified by ultrasound, or multiple prior preterm births thought to be due to cervical weakness. It may be planned in the first trimester for high-risk individuals or performed as a rescue procedure in the second trimester when signs of dilation or membrane bulging appear.

Techniques include vaginal cerklage, most commonly the McDonald or Shirodkar methods, and transabdominal cerklage used when vaginal cerklage is not feasible or has failed. Transabdominal cerklage is typically placed higher and may require planned cesarean delivery at term. The procedure is usually performed under regional or general anesthesia and can be done in an outpatient or surgical setting.

Postoperative care varies, but patients are monitored for signs of infection, bleeding, or preterm labor. Sutures are typically removed around 37 weeks of gestation or earlier if labor begins; transabdominal cerklage sutures are permanent and delivery is usually by cesarean section. The procedure reduces the risk of second-trimester loss and preterm birth in appropriately selected patients, but it is not universally effective and is not indicated for all pregnancies. Potential risks include infection, membrane rupture, suture failure, and rarely surgical complications.