Cervical stitch insertion for prevention of preterm birth and second trimester miscarriage

Cervical stitch insertion for prevention of preterm birth and second trimester miscarriage

Cervical cerclage during pregnancy is considered a preventive measure to prevent premature births or miscarriages in the second trimester of pregnancy.

The procedure involves placing a stitch in the cervix. This stitch provides structural support for the structure of the cervix and enables it to support the pregnancy until term.

Which women do we advise to put a stitch around the cervix?

Women who suffer from a weak cervix, meaning they are more susceptible to premature birth or recurrent second trimester miscarriages.

How is cervical dysfunction (weakness) diagnosed?

The diagnosis of cervical weakness is based on:

** The medical history of what happened in previous pregnancies.

**Ultrasound examination of the length of the cervix during pregnancy.

**Internal examination of the cervix during pregnancy.

Is there a test for cervical strength before pregnancy?

There is no radiological/clinical examination to evaluate the strength of the cervix before pregnancy occurs.

What is the benefit of cervical stitch?

**Provides support for the structure of the cervix and prevents premature dilatation.

**It maintains the cervical plug (mucous plug) inside the cervix, which prevents germs from entering through the cervix into the uterine chamber during pregnancy.

How do we determine the need for a cervical stitch based on “medical history”?

** History of 3 previous premature births (before 37 weeks)

**history of 3 previous miscarriages in the second trimester of pregnancy (where there is dilation of the cervix without pain or abdominal cramps)

How do we determine the need for a cervical stitch based on the “ultrasound examination”?

The cervix appears short on transvaginal ultrasound examination (less than 2.5 cm) with the presence of previous risk factors. Previous risk factors include:

- Surgeries on the cervix

- One or more premature births

- Miscarriage in the second trimester of pregnancy or more than one miscarriage

- Performing an emergency cesarean section in the previous pregnancy while the cervix was fully dilated at the time of emergency cesarean section.

When do we start performing serial ultrasound scans for cervical length measurement?

From week 14 to week 24, when the woman has risk factors for premature birth/miscarriage.

In the case of a twin pregnancy, does a stitch prevent premature birth?

Cervical stitch does not prevent premature birth/miscarriages in twin pregnancies.

What are the types of cervical stitch?

1- Vaginal stitch (placed through the vagina). There are two types: McDonald’s and Shirodkar.

2- Abdominal stitch (placed through laparoscope or laparotomy), which we resort to when the vaginal stitch fails.

When is the right time to place a cervical stitch?

It is placed during pregnancy between weeks 11 and 14 of pregnancy.

What do we mean by emergency cervical stitch?

It is a stitch that is placed when there is dilatation of the cervix (dilatation appears on the ultrasound device or internal examination) and the fetal membranes are exposed vaginally.

When can an emergency cervical stitch be placed?

It can be inserted at any time up to 28 weeks during pregnancy.

What are the contraindications for placing a stitch on the cervix during pregnancy?

- The presence of signs of infection inside the uterus.

- The presence of vaginal bleeding.

- Premature rupture of membranes.

- The presence of abnormalities in the fetus that are incompatible with life.

- The presence of uterine contractions.

What are the possible complications of placing a cervical stitch during pregnancy?

- Bleeding

- procedure failure

- Bladder injury

- Rupture of the membranes around the fetus

- infection

What tests should be performed before placing a stitch on the cervix?

- Initial fetal health examination (fetal anomaly scan) to ensure that there are no chromosomal abnormalities/deformities in the fetus.

- In cases of emergency cervical stitching, it is preferable to conduct inflammatory laboratory testing (c-reactive protein and white blood cell count) to ensure that there is no infection inside the uterus.

When is the cervical stitch removed?

- In emergency situations, such as contractions in the uterine wall (going into labor).

- If the woman does not suffer from labor contractions, it will be removed between the 36th and 37th week of pregnancy.

Dr Najeeb Layyous F.R.C.O.G

Consultant Obstetrician, Gynecologist and Infertility Specialist