Cervical Cerclage (The Stitch)

There are two primary surgical techniques used:

• McDonald Cerclage: The most common type. A simple, purse-string stitch is placed around the mid-part of the cervix.
• Shirodkar Cerclage: A more complex technique where the stitch is placed higher up on the cervix. This often requires the surgeon to move the bladder slightly and is considered more permanent, usually requiring a C-section for delivery or a second procedure to remove the stitch later.
• Abdominal Cerclage (TAC): In rare cases where vaginal stitches have failed, a stitch can be placed at the very top of the cervix via the abdomen (either laparoscopically or through an incision).

You may need a cerclage if:

• History-Indicated: You have had one or more late miscarriages (after 14 weeks) or very early premature births in the past.
• Ultrasound-Indicated: Your serial cervical length scans show the cervix is shortening to less than 25mm before 24 weeks.
• Rescue Cerclage: You are found to have a dilated cervix (sometimes with the amniotic sac protruding) during a routine check or after experiencing mild pressure.

The evaluation involves both history and high-resolution imaging:

1. Transvaginal Ultrasound: The 'gold standard' for measuring the internal length and shape of the cervix (looking for 'funneling').
2. Infection Screen: Before placing a stitch, we must ensure there is no current infection, as a stitch can sometimes trap bacteria.
3. Fetal Wellbeing: Confirming the baby is healthy and the amniotic fluid levels are normal.

The procedure is performed in an operating theater under regional anesthesia (spinal block):

• The Procedure: The surgeon carefully places the stitch around the cervix and ties it securely. For rescue cases, we may use a special balloon to gently push the amniotic sac back into the uterus before placing the stitch.
• Recovery: Most women stay in the hospital for 24 hours to monitor for any contractions. You will typically be advised to avoid strenuous activity for a period.
• Removal: For a vaginal stitch, the stitch is usually removed in the clinic at 36 to 37 weeks, allowing for a normal vaginal birth.

Cerclage has a strong track record of success:

• Elective Cases: For women with a history of cervical issues, a planned stitch has an 85-90% success rate in helping them reach a safe gestational age.
• Rescue Cases: Even when the cervix is open, a rescue cerclage can prolong the pregnancy by an average of 8-10 weeks, often making the difference between a viable and non-viable birth.
• Progesterone: In many cases, we combine the stitch with progesterone therapy (hormone support) for the best results.

If you have a history of late pregnancy loss or have been told your cervix is 'short,' you must be seen by a Maternal-Fetal Medicine specialist.

Our team, including Dr. Maria Haji Liga and Dr. Leanne Bricker, provides expert cervical surveillance and surgical management. We are one of the few centers in the region with the expertise to perform high-stakes rescue cerclage, offering hope and advanced care when every week of pregnancy matters.