Preterm birth is a multifactorial condition that can lead to neonatal mortality and morbidity. It occurs in every 6-8% of al births in Australia. (Corrine, L. et al 2016) There can be many reasons for preterm birth, but one cause can be related to the cervix. During pregnancy your cervix should remain long and firm. However, during the third trimester it begins to shorten and soften to prepare for birth. During this period, it may either shorten too much or become unable to maintain it’s integrity to keep baby within the uterus full term.
Preterm infants face higher rates of morbidity, respiratory distress, lung disease, brain trauma and cerebral palsy. By monitoring your cervical length and integrity this is an easy way to prevent a risk factor for preterm birth.
Cervical Cerclage or cervical stitch is an operation that your obstetrician may consider if your cervix is having trouble maintaining its shape or position during pregnancy. It is an option when your cervix length is less than 10mm, less than 4cm dilated or you have an incompetent cervix. These are all factors that are identified through ultrasound imaging during your regular checks, along with your previous medical history.
This is often not the first line of treatment if you have a problem with your cervix while pregnant. If your obstetrician decides that this procedure will benefit you, then while under a local anaesthetic they will suture the cervix closed temporarily. This is to avoid the cervix dilating and lead to a higher birth weight and longer gestation time. The stitch itself is like a “purse string” around the cervix to ensure closure and to avoid preterm labour.
This procedure is generally only considered if you have:
- A history of one or more second trimester pregnancy losses related to cervical dilation.
- Prior cerclage due to cervical insufficiency in second trimester
This procedure is not without risks. Complications that may occur include:
- Unintentional breaking of the waters
- Lacerations at the cervix
- Complications related to anaesthesia
This is why your obstetrician will always take into consideration your previous pregnancy history, current symptoms, and a physical examination to choose if this procedure is appropriate for you.
After having this procedure done there may be some vaginal bleeding or brownish discharge for 1-2 days after the operation. Your stitches should be removed in the hospital around 36-37 weeks gestation unless you go into labour before then.
After a cervical cerclage placement, it is recommended that you do not participate in aerobic exercise to avoid preterm labour. (Satterfield, N. et al 2016). In speaking with your obstetrician, they’ll be able to give you more targeted advice on things to avoid as there is different opinions you find online. Working with your Obstetrician, GP and women’s health physiotherapist will be important to help keep you as healthy as possible throughout your pregnancy.
The physiotherapists at Bump Fitness are always here to help you on your pregnancy and postnatal journey with our training in pelvic floor health and pregnancy to give you evidence based treatments.
Until next time,
- Bieber KB, Olson SM. Cervical Cerclage. [Updated 2022 Aug 1]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK560523/ https://www.ncbi.nlm.nih.gov/books/NBK560523/#:~:text=Cervical%20cerclage%20is%20performed%20as,findings%20in%20a%20current%20pregnancy.
- Lu C, Lim B, Robson SJ. Increasing Incidence Rate of Cervical Cerclage in Pregnancy in Australia: A Population-Based Study. Healthcare (Basel). 2016 Sep 12;4(3):68. doi: 10.3390/healthcare4030068. PMID: 27626455; PMCID: PMC5041069.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5041069/
- Satterfield N, Newton ER, May LE. Activity in Pregnancy for Patients with a History of Preterm Birth. Clin Med Insights Womens Health. 2016 May 19;9(Suppl 1):17-21. doi: 10.4137/CMWH.S34684. PMID: 27226741; PMCID: PMC4874745.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4874745/
- Photo from Wikipedia – Cervical cerclage – Wikipedia