Cervical Cerclage: An Effective Solution for Preventing Preterm Birth

Preterm birth is one of the leading causes of infant mortality and morbidity, leaving many health consequences for the baby and a burden on families. For women with a history of preterm birth or cervical insufficiency, cervical cerclage is considered an effective solution to prolong pregnancy. This method plays an important role in protecting the health of both mother and baby, offering hope to many families for a healthy and full-term pregnancy.

1. You should know

Cervical cerclage is a surgical procedure performed during pregnancy, aimed at placing a stitch (suture) around the cervix to provide mechanical support and keep the cervix closed, thereby reducing the risk of preterm birth [1].
This procedure is particularly effective in reducing the risk of preterm birth before 34 weeks in high-risk women [1].
Cervical cerclage may be indicated based on the patient's obstetric history, ultrasound results, or in emergency cases when the cervix has already begun to dilate [1].
Although cerclage helps reduce the risk of preterm birth, it does not completely eliminate this possibility and may carry some minor risks [1].

2. Causes of Preterm Birth and Indications for Cervical Cerclage

2.1. Cervical Insufficiency (Incompetent Cervix)

Cervical insufficiency, also known as an incompetent cervix, is a condition where the cervix opens too early in pregnancy without any signs of labor or contractions. This can lead to late miscarriage or preterm birth. Cervical cerclage is indicated to create a mechanical barrier, keeping the cervix closed and supporting the fetus to develop to term.

2.2. History of Preterm Birth or Late Miscarriage

Women with a history of preterm birth or late miscarriage in previous pregnancies due to cervical insufficiency are often considered for prophylactic cervical cerclage. This is one of the most common indications for the procedure.

2.3. Other Risk Factors

Several other factors can increase the risk of preterm birth and need to be evaluated by a doctor to consider cervical cerclage, including:

Infections: Genital tract infections can cause inflammation and weaken the cervix.
Uterine abnormalities: Congenital uterine abnormalities can affect the ability to carry a pregnancy.
Previous cervical surgery: A history of loop electrosurgical excision procedure (LEEP) or conization may reduce cervical length and strength.

3. Types of Cervical Cerclage

There are three main types of cervical cerclage, indicated depending on the patient's condition and the timing of risk detection:

3.1. History-indicated cerclage

This is a prophylactic cerclage, usually performed at 12-14 weeks of gestation, before the cervix shows any signs of opening. This indication is based on the mother's obstetric history, such as previous unexplained preterm birth or late miscarriage [1].

3.2. Ultrasound-indicated cerclage

This procedure is performed when ultrasound reveals a short cervix (usually <25mm) in women at risk of preterm birth, even without a clear history of preterm birth. Ultrasound-indicated cerclage is typically performed between 14-23 weeks of gestation [1].

3.3. Emergency/Physical exam-indicated cerclage

This is an emergency cervical cerclage performed when the cervix has already begun to open or there are signs of early labor, typically in the mid-trimester. The purpose is to prevent imminent preterm birth [1].

4. Cervical Cerclage Procedure

4.1. Pre-procedure preparation

Before cervical cerclage, the patient will undergo a general examination, blood tests, and ultrasound to assess the fetal and cervical condition. The doctor will explain the procedure, its benefits, risks, and post-procedure precautions in detail. The patient needs to fast as instructed by the doctor.

4.2. Steps of the procedure

Cervical cerclage is usually performed under regional anesthesia (spinal or epidural). There are two main techniques:

McDonald technique: This is the most common technique, where the doctor places a stitch around the outside of the cervix and ties it like a purse-string [1].
Shirodkar technique: The stitch is placed deeper, through the tissues surrounding the cervix, often requiring a small incision in the cervix [1].

The stitch will be kept in place until about 36-37 weeks of gestation or until signs of labor appear.

4.3. Post-procedure care

After the procedure, the patient may experience mild discomfort, vaginal bleeding, or uterine contractions. The doctor may prescribe pain relievers and uterine relaxants. The patient needs to rest, avoid strenuous activities, and refrain from sexual intercourse for a certain period as advised by the doctor.

5. Effectiveness and Benefits of Cervical Cerclage

5.1. Reduced rate of preterm birth

Many studies have shown that cervical cerclage significantly reduces the risk of preterm birth, especially preterm birth before 34 weeks, in high-risk women [1]. This helps prolong pregnancy, allowing the fetus more time to develop vital organs.

5.2. Improved outcomes for newborns

Prolonging pregnancy thanks to cervical cerclage can improve health outcomes for newborns, including reducing infant mortality and severe complications associated with preterm birth [1].

5.3. Comparison with other methods

Cervical cerclage has been shown to be as effective or superior to some other preterm birth prevention methods, such as vaginal progesterone, in certain patient groups [1, 3]. A recent meta-analysis suggests that combining cervical cerclage and vaginal progesterone may lead to a higher reduction in preterm birth compared to using a single method alone [3].

6. Potential Risks and Complications

Despite its benefits, cervical cerclage can also be associated with some risks and complications, including:

6.1. Short-term

Infection: Chorioamnionitis (infection of the amniotic sac) or local infection at the stitch site [1].
Bleeding: Mild bleeding is normal, but heavy bleeding needs monitoring.
Uterine contractions: May occur after the procedure, sometimes leading to early labor [1].
Premature rupture of membranes (PPROM): Although rare, the procedure can cause PPROM [1].
Cervical injury: May occur during the procedure.

6.2. Long-term

Long-term complications are generally rare. Some studies suggest that the rate of cesarean section may be slightly higher in women who have undergone cervical cerclage [1].

6.3. Warning signs to watch out for

Patients should contact their doctor immediately if they experience any of the following signs after cervical cerclage:

Heavy, bright red vaginal bleeding.
Vaginal discharge with a foul odor or unusual color changes.
Fever or chills.
Severe lower abdominal pain or regular, increasing uterine contractions.
Rupture of membranes (a gush of fluid from the vagina).

7. When to see a doctor

If you are pregnant and have a history of preterm birth, late miscarriage, or have been diagnosed with a short cervix, discuss preterm birth prevention options with your obstetrician, including cervical cerclage. Early examination and evaluation will help the doctor make the most appropriate decision for your situation.

After cervical cerclage, if you experience any of the warning signs listed above or have any concerns about your health and the fetus, go to a medical facility immediately for examination and timely treatment.

8. Frequently Asked Questions (FAQ)

Is cervical cerclage painful? Cervical cerclage is usually performed under regional anesthesia (spinal or epidural), so you will not feel pain during the surgery. After the procedure, there may be mild discomfort or dull pain in the lower abdomen, but it can usually be managed with pain medication.
When is the cerclage stitch removed? The cervical cerclage stitch is usually removed around 36-37 weeks of gestation, or earlier if there are signs of labor, rupture of membranes, or infection. Stitch removal usually does not require anesthesia and may cause mild discomfort.
Can I have sexual intercourse after cervical cerclage? Typically, doctors will advise patients to abstain from sexual intercourse for a period after cervical cerclage to avoid uterine stimulation and reduce the risk of infection. The specific abstinence period will be guided by the doctor depending on each individual's situation.
Does cervical cerclage guarantee no preterm birth? Cervical cerclage is an effective method to reduce the risk of preterm birth in high-risk women, but it does not 100% guarantee prevention of preterm birth. The effectiveness of the procedure depends on many factors, including the underlying cause of the risk, the timing of the procedure, and the overall health status of the patient.
What should I note about diet and activities after cervical cerclage? After cervical cerclage, patients need to maintain adequate rest, avoid strenuous activities, heavy lifting, and excessive movement. Regarding diet, there are no specific requirements other than maintaining a balanced, nutritious diet as during normal pregnancy. Prevent constipation by consuming enough fiber and water.

9. Information review & references

Information review:

Professional consultation: CN. Truc Thanh Mai - Department of Obstetrics and Gynecology, University Medical Center HCMC
Date updated: 2025-11-20

References:

[1] Zarko Alfirevic, Tamara Stampalija, Nancy Medley (2017). Cervical stitch (cerclage) for preventing preterm birth in singleton pregnancy. PMC. Accessed: 2025-11-20.
[2] Xiaotian Ni, Shengyao Lei, Shen Li, Xiaoning Yang, Xiaona Li, Yijie Gao, Xiujuan Su, Yun Liu, Ming Liu, Tao Duan (2025). Efficacy of late cervical cerclage for preventing preterm birth in pregnancies complicated by cervical incompetence: retrospective cohort study. PubMed. Accessed: 2025-11-20.
[3] Anne-Marie Aubin, Liam McAuliffe, Kimberley Williams, Ashad Issah, Rosanna Diacci, Jack E McAuliffe, Salma Sabdia, Jason Phung, Carol A Wang, Craig E Pennell (2023). Combined vaginal progesterone and cervical cerclage in the prevention of preterm birth: a systematic review and meta-analysis. PubMed. Accessed: 2025-11-20.

The information provided is for reference purposes only and should not be considered as medical advice. Please consult a doctor for detailed consultation.