Interviewed Expert: Dr. Zhu Ninghu, Chief Physician and Director of Obstetrics, Guangdong Provincial Second People's Hospital
Cervical insufficiency is a leading cause of recurrent mid-term miscarriages. Many patients experience cervical dilation without abdominal pain or bleeding, leading to protrusion of the amniotic sac and eventual miscarriage. Cervical cerclage is the most effective method to help patients with cervical insufficiency carry their babies to term.What is cervical cerclage? When is the optimal time for the procedure? What precautions should be taken? Let's hear from Dr. Zhu Ninghu, Director of Obstetrics at Guangdong Provincial Second People's Hospital, as he addresses common questions about cervical cerclage for our readers.
Dr. Zhu Ninghu, Chief Physician of Obstetrics, Guangdong Provincial Second People's Hospital
1. What is cervical cerclage?
Dr. Zhu: Simply put, cervical cerclage involves suturing a loop of thread as close as possible to the internal cervical os to bind the cervical opening. This maintains pregnancy until full term, or at least until 33 weeks gestation, ensuring the baby's viability.
2. Which pregnant women require cervical cerclage?
Dr. Zhu Ninghu: Women with a history of late miscarriage (between 12-24 weeks of pregnancy) should undergo cervical evaluation before subsequent pregnancies to diagnose cervical insufficiency. If diagnosed, cervical cerclage may be performed.
3. When is the optimal timing for cervical cerclage?
Director Zhu Ninghu: The procedure can be performed either before conception or two weeks prior to the gestational week at which the previous miscarriage occurred. For example, if the first pregnancy ended in miscarriage at 18 weeks, cerclage should be performed at 16 weeks of the subsequent pregnancy.Some doctors claim "it's too late for cerclage," but I disagree. As long as the baby hasn't been born and cerclage can improve the baby's prognosis, the procedure should be performed. Moreover, cervical cerclage does not increase the rate of cesarean sections or pose any additional risks. Eligible expectant mothers can still choose natural childbirth.
4. What is the difference between elective cervical cerclage and emergency cervical cerclage?
Director Zhu Ninghu: Cervical cerclage refers to an elective procedure performed before or after conception to prevent miscarriage. Emergency cervical cerclage is performed when a pregnant woman exhibits symptoms of miscarriage and requires urgent surgery.For example, IUDs are actually more prone to causing inflammation, yet infections resulting from IUD placement are extremely rare. Patients typically request IUD removal only due to discomfort or heavy menstrual bleeding. Having performed over 700 cervical cerclage procedures, I have never encountered a single case of infection caused by the surgery itself.
6. Can cervical cerclage be performed if I have vaginitis?
Director Zhu Ninghu: Some believe vaginal inflammation could cause infection during cervical cerclage, making it unsuitable. This is a misconception. While inflammation may affect surgical outcomes, cervical dilation is a sign of impending miscarriage. Delaying cerclage to treat vaginal inflammation first risks missing the optimal window for the procedure. Once miscarriage occurs, it's too late.Performing the cerclage first and treating the inflammation afterward may slightly affect the cerclage's effectiveness, but it won't delay the procedure.
7. Are there complications with cervical cerclage? Could it cause harm?
Director Zhu Ninghu: There are no complications. Minor bleeding may occur after the procedure, but this is normal bleeding from the sutures and will subside quickly.
8. If strong contractions occur during mid-pregnancy, can cervical cerclage still be performed to save the fetus?
Director Zhu Ninghu: Cervical cerclage is ineffective for miscarriages caused by pronounced, strong contractions. Once contractions begin, few medications can control them. Forcing a cerclage procedure may cause uterine rupture.Cervical cerclage cannot treat all cases of preterm labor, but it is highly effective for cervical insufficiency without significant contractions, inevitable miscarriage, twin pregnancies, and prophylactic cerclage for preterm labor.
Expert Profile:
Zhu Ninghu, Chief Physician and Director of Obstetrics at Guangdong Provincial Second People's Hospital. With nearly 30 years of dedicated clinical work in obstetrics, he has accumulated extensive experience. He has performed over 700 cervical cerclage procedures for patients nationwide.
He possesses extensive expertise in treating gestational hypertensive disorders, recurrent miscarriage due to cervical insufficiency, preterm labor, intrauterine growth restriction, and placenta previa. He is proficient in performing various obstetric open surgeries and vaginal delivery procedures, including extraperitoneal cesarean section, cervical cerclage, forceps delivery, vacuum extraction, repair of third-degree perineal lacerations,and neonatal advanced life support techniques. She excels in managing complex obstetric conditions and critical emergency care.