Abdominal Cerclage
A cerclage is a surgical procedure designed to reduce the risk of early labor or pregnancy loss in the second trimester, typically due to cervical insufficiency. The procedure consists of either inserting strong non-absorbable sutures or placing a specialized tape around the cervix to help keep it closed until delivery.
When Might I Require a Cervical Cerclage?
The cervix typically remains firm and intact throughout most of your pregnancy, only softening, thinning, and dilating later in the third trimester in preparation for childbirth.
In the case of cervical insufficiency, the cervix becomes weak and begins to open too early, often leading to a miscarriage in the second trimester because it cannot support the weight of a developing baby.
Dr. Okour uses three main criteria to determine if a cerclage is necessary:
- History-Based Criteria: If you've had two or more second-trimester losses due to painless cervical dilation, and no other complications are present.
- Ultrasound-Based Criteria: If you’ve previously experienced a preterm birth, and an ultrasound shows signs of cervical shortening or thinning.
- Physical Exam-Based Criteria: A pelvic exam may reveal early cervical dilation. If this occurs, you may need a "rescue cerclage" or an exam-based cerclage to prevent further complications.
How is the Procedure Performed?
There are two main types of cerclage procedures:
Vaginal Cerclage
In a vaginal cerclage, Dr. Okour accesses the cervix through your vagina, placing the suture in the lower half of the cervix. This method is usually preferred if it is a feasible option because it is less invasive.
Abdominal Cerclage
If a vaginal cerclage has been ineffective in the past or if you cannot undergo a vaginal procedure, an abdominal cerclage may be necessary. Dr. Okour typically performs abdominal cerclage before pregnancy occurs, although it can also be done early in the pregnancy if needed.
This procedure involves minimally invasive laparoscopic surgery, whereas a small incision is made in the abdomen and a slim scope is inserted to access the cervix. The suture is then placed higher up on the cervix, near where it connects with the uterus.
Does an Abdominal Cerclage Impact My Delivery?
After an abdominal cerclage, you will need to have a cesarean section (C-section) to deliver your baby, as the suture remains in place until after birth. The stitch can be removed after delivery or left in if you plan to have more children in the future.
By contrast, a vaginal cerclage is usually removed around the time of delivery, allowing for a vaginal birth.