Cervical suture (cervical cerclage)

Cervical suture - Indications

Circular suturing of the cervix is a procedure used in gynaecology to prevent premature births. In addition to the suture, pessaries and progesterone are also used in practice. Cervical suturing has a proven effect in patients with risk factors, e.g. a history of premature birth and a shortened cervix (<25mm before the 24th week), among others.

Prophylactic cervical suture

A prophylactic cervical suture is performed on patients with a history of at least 3 late miscarriages (after the 16th week) or premature births. Pregnant women who have undergone cervical conisation, for example, may also be considered for a prophylactic cervical suture. The suture is usually placed in the first trimester of pregnancy (around the 14th week of pregnancy) and is intended to reduce the risk of a premature birth. In most cases, the pregnant woman takes a 200ug dose of intrapartum progesterone in addition to the cervical suture.

Emergency cervical suture

An emergency cervical suture is an emergency procedure that is performed when the cervix is actively shortened or even dilated. Doctors apply an emergency cervical suture even if the foetal bladder is visible in the speculum. The emergency suture is usually placed before the 26th week of pregnancy. It is removed again when labour begins, the amniotic fluid drains or the 36th week of pregnancy has passed.

Cervical suture - how is it inserted?

The decision to insert a cervical suture is made by a gynaecologist. The procedure itself takes place in hospital. The patient is usually given antibiotic prophylaxis beforehand, as the shortening of the cervix is often associated with an intrauterine infection. In addition, in some situations a so-called amnioreduction is performed to shorten the procedure and thus facilitate the technical requirements for inserting the suture. The suture on the cervix itself is usually placed transvaginally and consists of temporarily "closing" the outer cervix with an insoluble suture. The procedure is performed under partial or general anaesthesia under sterile conditions.

Cervical suture - complications

Like any medical procedure, the insertion of a cervical suture can be associated with complications. The most frequently mentioned, but rarely occurring complications include Amniotic fluid leakage or intrauterine infections.