Name of the Procedure:

Cerclage of Uterine Cervix, Nonobstetrical

Summary

In simple terms, a cerclage of the uterine cervix is a surgical procedure where a stitch is placed around the cervix to keep it closed. This is done to prevent or treat conditions where the cervix is weak and unable to stay closed on its own, causing issues such as cervical insufficiency.

Purpose

This procedure addresses issues related to cervical insufficiency, which can lead to conditions like cervical incompetence. The main goal is to reinforce the cervix and prevent its premature opening, thereby avoiding potential complications.

Indications

• Recurrent pregnancy loss
• Cervical incompetence
• Short or weakened cervix
• Certain cervical abnormalities

Patient criteria include having a history of cervical insufficiency or related conditions identified through diagnostic evaluations.

Preparation

• Fasting may be required a few hours before the procedure.
• Adjustments to any medications should be guided by the healthcare provider.
• Pre-procedural diagnostic tests may include a pelvic exam, ultrasound, or cervical assessment.

Procedure Description

1. The patient receives local, regional, or general anesthesia.
2. A speculum is inserted into the vagina to access the cervix.
3. Surgical tools are used to place a stitch around the cervix.
4. The stitch is tightened to keep the cervix closed and secure.
5. The tools are removed, and the procedure site is cleaned.

Duration

The procedure typically takes about 30-60 minutes.

Setting

Cerclage of the uterine cervix is usually performed in a hospital or an outpatient surgical center.

Personnel

• Gynecologist or obstetrician (surgeon)
• Anesthesiologist or nurse anesthetist
• Surgical nurses and assistants

Risks and Complications

• Infection
• Cervical laceration or injury
• Preterm labor
• Premature rupture of membranes
• Discomfort or pain

Benefits

• Stabilizes the cervix and reduces the risk of premature opening
• Lowers the chances of associated complications
• Can improve pregnancy outcomes

Recovery

• Pain management with prescribed medications
• Rest and avoiding heavy lifting or strenuous activities
• Follow-up appointments for monitoring
• Possible restrictions on intercourse for a certain period

Alternatives

• Progesterone therapy
• Cervical pessary
• Close monitoring without intervention

Each alternative has its own risks and benefits, and the choice depends on the individual patient's condition and medical history.

Patient Experience

• The patient might experience mild discomfort during the procedure due to the position and instruments used.
• Post-procedural pain or cramping is common and can usually be managed with pain relief measures.
• Most patients can resume normal activities within a few days, but with some restrictions as advised by the healthcare provider.