Name of the Procedure:

Cerclage of the Cervix during Pregnancy; Vaginal (Cervical Stitch)

Summary

In simple terms, a cerclage of the cervix is a surgical procedure performed during pregnancy to stitch the cervix closed to prevent premature birth or miscarriage. This is usually done through the vaginal route.

Purpose

This procedure addresses cervical insufficiency, where the cervix begins to open too early in pregnancy, increasing the risk of premature birth. The goal is to strengthen the cervix, thereby supporting pregnancy to a safer duration.

Indications

• History of second-trimester miscarriages due to cervical insufficiency
• Physical findings of a short or weakened cervix through ultrasound or pelvic exam
• Previous preterm birth with a demonstrated cervical factor

Preparation

• Patients may need to fast for a few hours before the procedure.
• Diagnostic tests such as ultrasounds will be performed to assess the status of the cervix.
• Patients might need to adjust certain medications as advised by their healthcare provider.

Procedure Description

1. Preparation: The patient is placed in a position that provides access to the cervix.
2. Anesthesia: A regional (spinal or epidural) or general anesthesia is administered.
3. Access: A speculum is inserted into the vagina to visualize the cervix.
4. Stitching: Sutures are placed in and around the cervix to cinch it closed, usually using a needle and strong thread.
5. Closure: Once stitched, the cervix is inspected to ensure the suture is secure, and the speculum is removed.

Duration

The procedure typically takes about 30 to 45 minutes.

Setting

Cerclage is usually performed in a hospital or surgical center.

Personnel

• Obstetrician/Gynecologist (the surgeon)
• Anesthesiologist or nurse anesthetist
• Surgical nurse

Risks and Complications

• Infection
• Cervical laceration or tearing
• Preterm labor
• Premature rupture of membranes (water breaking)
• Bleeding

Benefits

• Reduces the risk of premature birth
• Provides a greater chance of carrying the pregnancy to a viable term

Recovery

• After the procedure, patients might experience mild cramping or spotting.
• Bed rest for a few days or activity restrictions may be recommended.
• Follow-up appointments for cervix checks are necessary.
• Complete pelvic rest (no sexual intercourse) might be advised.

Alternatives

• Progesterone supplementation
• Pessary (a device placed in the vagina to support the cervix)
• Bed rest or activity restriction without surgical intervention

Each alternative has its pros and cons; for instance, progesterone can help but may not be as effective for severe cases of cervical insufficiency.

Patient Experience

• During the procedure: With adequate anesthesia, the patient should not feel pain but may feel some pressure.
• After the procedure: Mild discomfort or cramps are common, which can be managed with pain relievers.
• Emotional reassurance and clear communication from the healthcare team can significantly improve the patient's comfort and experience.