Chapter 233 Cervical Cerclage
DESCRIPTION
Cervical cerclage is the placement of a suture or tape to support and partially occlude the uterine cervix to reduce the risk of preterm delivery in the face of cervical insufficiency. A number of procedures have been described, but the most common and simplest is the McDonald cerclage, which is described here. Cervical cerclage may also be accomplished by placing the suture by an abdominal route, although this is a much more invasive procedure and the suture is generally left in place permanently, precluding vaginal delivery.
INDICATIONS
Cervical incompetence as documented by a history of preterm pregnancy loss associated with painless cervical dilation or prolapse and ballooning of the fetal membranes into the vagina without labor. Prophylactic cervical cerclage is generally delayed until after 14 weeks so that early pregnancy losses from other factors may be resolved.
CONTRAINDICATIONS
Bleeding, uterine contractions, obvious infection, or rupture of the membranes. Beyond 24 to 26 weeks, bed rest or other treatments are often preferred because of the increased risk of surgically related labor.
REQUIRED EQUIPMENT
TECHNIQUE
After appropriate informed consent has been obtained, ultrasonography should be performed to confirm a living fetus, exclude major fetal anomalies, and assess cervical length. Any obvious vaginal or cervical infections should be treated, and cultures for gonorrhea, chlamydia, and group B streptococci should be obtained prior to proceeding. (Sexual intercourse is generally proscribed for 1 week before and after the procedure.)
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