About the operation

We have recommended that you have a cerclage procedure to prevent preterm birth. A cervical cerclage involves temporarily sewing the cervix closed with stitches. A cerclage is usually placed after the 1st trimester ultrasound or as an acute procedure if the cervix shortens during the 2nd trimester. We can place the cerclage up to the 23rd week of pregnancy.

Most people can go home within 24 hours, while others will need to stay at the hospital a little longer. Some women are bedbound for a period of time after the procedure.

Important preparation

Take a shower or bath at home

On the day before the operation, take a bath or shower and wash your hair. Put on clean clothes before heading to the hospital. Do not apply any creams, deodorant or perfume after the shower or bath as this increases the risk of infection.

Remove make up, nail polish and jewellery

During the operation we will measure your oxygen levels by placing a small, clip-like device to your finger. You should therefore remove any nail polish or fake nails prior to the procedure. Remove all make up and piercings before leaving for the hospital and leave watches and jewellery at home.

Fasting

You must fast before the operation. This means that:

• You must stop eating 6 hours before the operation.
• You must stop drinking dairy products and juice with pulp 6 hours before the operation. Do not use milk in your coffee or tea.
• You must stop drinking all forms of cold or hot liquids 2 hours before the operation. We recommend having a large glass of cordial as the last thing you drink. The sugar in the cordial helps counteract nausea and malaise.

Your stomach must be empty in order to avoid any stomach content from moving up through your oesophagus and into your lungs while you are sedated.

Special precautions apply if you have diabetes. We will discuss this with you.

At the hospital

You will be given patient clothing to wear

We will provide you with clothing to wear during the operation.

You may be given medication to inhibit contractions

You may be given medication to inhibit contractions via an intravenous drip in your arm. In some cases, the medication can be provided in tablet or suppository form.

Sedation

Sedation is usually done via epidural. You will be awake and be able to feel pressure and tugging but no pain. If another form of sedation is used, we will discuss this with you beforehand.

The operation

You will be asked to lie on your back and have your legs in supports as during a normal gynaecological examination. The physician will then place a stich in your cervix.

The operation will take approximately 15 minutes.

After the operation

You will be in a recovery room for a few hours after the operation. You will be connected to equipment that monitors your heart rhythm, blood pressure and temperature. After 1-2 hours, you will return to the ward until you are ready to go home.

Let us know if you feel any pain

We can help alleviate any pain you may feel. Tell us if you are in pain or if you feel unwell, so we can help you. You may need pain-relieving medicine.

Vaginal bleeding

You may experience light vaginal bleeding right after the operation. This is normal and these symptoms will go away on their own after a couple of days.

Risks of a cervical cerclage

There is a risk of discomfort and complications during and after all operations. If there are factors that make you particularly at risk, we will discuss them with you.

Foetal membrane rupture (frequency: up to 4%): In rare cases, the foetal membrane might rupture during the operation if the foetal membranes are visible or if the cervix is very shortened. This can lead to a late-term miscarriage or preterm birth.

Infected uterus (frequency: less than 1%): In very rare cases, the uterus can become infected. If this happens, we will remove the cerclage. In very rare cases, the infection can lead to miscarriage or preterm birth.

Going home

Contact us if you experience Braxton Hicks contractions, a downward pull in your abdomen, or if you begin bleeding. Contact us if you develop one or more of the following symptoms, as they may be a sign that the cervix is shortening or opening up:

• Many Braxton Hicks contractions that do not stop, even when resting.
• A downward pull in your vagina.
• Vaginal bleeding.

Removal of the cerclage

The cerclage will be removed 2-4 weeks before your due date. The stiches are removed without sedation.

The cerclage will be removed earlier than intended if your contractions begin or you if your water breaks.

Sex

In some cases, we recommend that you do not have sex while the cerclage is in place.

Sick leave

The need for sick leave depends on the individual. Talk to your obstetrician about what is best for you. However, your general practitioner is the one who prescribes sick leave.

Check-ups

You may be offered additional check-ups during pregnancy if necessary.