Cervical cerclage is generally performed for women with recurrent miscarriages or preterm labor. Different surgical techniques exist depending on the procedure's implementation. Today, we'll introduce the most common types of cervical cerclage.
Common Surgical Methods
Cervical Cerclage: This simpler technique is most frequently used clinically. At the cervix-vagina junction, sutures are passed through the mucosal layer and muscle layer, then back through the mucosa. Four to five stitches are placed in a circular pattern around the cervix, carefully avoiding the bilateral blood vessels, followed by knotting. Its advantages include simplicity and ease of suture removal. However, its effectiveness is slightly inferior to the Shirodkar method.
Shirodkar Method: Typically performed after 12 weeks of gestation. Surgery before 12 weeks carries a higher risk of miscarriage, while later procedures may be less effective due to cervical dilation. This technique involves ligating around the internal os of the cervical canal.Make small transverse incisions in the anterior and posterior fornix. Pass suture needles through the vaginal submucosa from the anterior fornix incision to emerge at the posterior fornix incision, tie off. Place two sutures (one upper, one lower), then close the incisions.
Cervical laceration repair with reinforced Shirodkar suturing: For old cervical lacerations extending to the fornix, perform interrupted interrupted suturing with 2–3 stitches using 00000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000
Lash procedure: In non-pregnant women with a history of recurrent late miscarriages or failed mid-pregnancy cerclage, the Lash procedure may be performed to correct cervical incompetence.
So, how should care be managed after cervical cerclage?
Principles of Postoperative Cervical Cerclage Care
Absolute bed rest is essential. Lie flat without a pillow for 6–8 days, monitoring for abdominal pain, lower abdominal heaviness, uterine contractions, and bleeding.
Avoid unclean or highly irritating foods to prevent diarrhea, which may increase miscarriage risk.
Increase intake of high-fiber foods to prevent constipation. Constipation after cervical cerclage arises from multiple factors. Accumulation of hard stool in the rectum can trigger intense intestinal contractions, which may induce uterine contractions and increase the risk of miscarriage or premature birth. A high-fiber diet is the best approach for treating and preventing constipation. Pregnant women are encouraged to consume soluble fiber-rich foods, such as bananas and honey.
Drink 2000–3000 ml of water daily. The optimal time for bowel movements is after breakfast. Develop a regular bowel routine and avoid straining during defecation to prevent uterine contractions.
Avoid touching the breasts or abdomen to prevent triggering contractions.
Maintain strict personal hygiene, keep the perineal area clean, and refrain from taking baths or engaging in sexual activity.Additionally, psychological well-being is crucial post-surgery. Family members should provide emotional support to alleviate stress. Adhere strictly to prescribed medication schedules and attend all prenatal appointments. Seek immediate medical attention for symptoms like abdominal pain, lower back soreness, pelvic heaviness, bleeding, or fluid leakage. If experiencing regular contractions that increase in frequency, seek emergency hospitalization to remove cervical sutures promptly to prevent cervical laceration.If pregnancy is successfully maintained to full term (37 weeks), hospitalization is required for suture removal.If abdominal pain, lower back soreness, lower abdominal heaviness, bleeding, or fluid leakage occurs, seek medical attention promptly. If intermittent uterine contractions occur and gradually increase in frequency, immediate hospitalization is required to remove the cervical suture to prevent cervical laceration. If the pregnancy is successfully maintained to full term (37 weeks), hospitalization is also necessary for suture removal.