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Cerclage Operation

Cervical incompetence is a medical condition where there is structural weakness in the neck of the womb (cervix). It is usually the result of prior injury such as an abortion or from an inherited condition. The physical weakness in the cervix makes it susceptible to "giving way" as the baby becomes larger and heavier.

Typically, the cervix opens up silently with minimal womb contractions in the second trimester of pregnancy. This is followed by a sudden gush of amniotic fluid when membranes rupture. The baby is delivered prematurely following a short labor. Accurate diagnosis is usually difficult because there are no well-defined criteria.

In most cases, the condition is diagnosed in retrospect, after one or more miscarriages in the second trimester. Recently, using ultrasound technology, objective evaluation of the cervix during pregnancy has become possible. Cervical incompetence is now more readily detected by continuous monitoring in women with a history of second-trimester miscarriage.

Once incompetence is diagnosed, this may be treated through a surgical procedure called cerclage where a purse string suture is placed around or through the cervix to keep it tightly closed. This is usually performed after the twelfth week of pregnancy, after ultrasound evaluation has indicated a live baby with no apparent abnormalities. Cerclage can also be done for twin pregnancies.

The Risks In The Operation Are Usually Minimal And They Include:

  • Premature contractions of the womb leading to miscarriage;
  • Membranes of the water bag may be punctured accidentally and the baby delivered prematurely;
  • Infection of the cervix causing a miscarriage; 
  • Tearing of the cervix if labor happens before the stitch is removed;
  • Scarring of the cervix causing difficulty in opening up during labor;
  • Risks associated with general anaesthesia such as vomiting and nausea.

The patient should be monitored carefully after the operation. Bed rest is recommended for a few days so as to remove any pressure on the cervix and increase the chances of retaining the pregnancy. Sexual intercourse, heavy exertion and prolonged standing should be avoided for a week at least.


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