Cerclage in pregnancy

Most often, cerclage refers to a procedure where the cervix (also called the cervix uteri) is stitched with a firm thread or band, either from the outside or the inside. The aim is to prevent the cervix from opening too early. This is because in some pregnant women, the cervix is too weak and shortens or opens too soon, which greatly increases the risk of premature birth.

A cerclage is usually considered when there have already been problems with premature or miscarried pregnancies in the past, or when a significant shortening of the cervix is found in the current pregnancy. The procedure is usually carried out between weeks 12 and 16 of pregnancy and is done under a short general anaesthetic. A strong thread is placed like a loop around the cervix and is removed at the end of pregnancy, usually around week 37.

When is a cerclage necessary?

The decision about whether a cerclage is the right choice depends on several factors. Not every case of cervical shortening makes this procedure necessary. Doctors carefully weigh up whether the risk of premature birth is high enough to justify the procedure. Medical history also plays a role: those who have previously had a late miscarriage or a very early birth are often offered this option more readily.

There are also cases where, during an ongoing pregnancy, for example after a sudden shortening of the cervix, an "emergency cerclage" is placed. In these situations, the aim is to keep the baby in the womb for as long as possible in order to improve the chances of survival.

What risks and worries are there?

Many people ask whether a cerclage is dangerous or whether it can cause complications. As a general rule, every surgical procedure carries certain risks, such as infections, bleeding, or early contractions. However, most cerclages go ahead without major problems. It is completely normal to feel worried. The idea of having surgery on the cervix can feel frightening for many people. It is important to speak openly with your doctor about any questions or concerns.

Some people worry about whether the cerclage will affect the baby, or whether it needs to be removed after birth. The answer is that the thread or band is released in good time before birth, and this usually happens straightforwardly in hospital. In rare cases, early contractions or a rupture of membranes can occur even with a cerclage in place. This is why regular check-ups are planned throughout.

Cerclage outside of gynaecology

The term also appears in other medical specialities. In orthopaedics, for example, cerclages are used to hold bone fragments together after a fracture, using a wire placed around the bone. Here, the cerclage acts as additional stabilisation until the bone has healed back together firmly. In dentistry or in operations on blood vessels, a similar technique can be used to secure structures.

Different spellings and forms

Sometimes the alternative spelling "circlage" or the term "cerclage suture" can be found. All of these refer to the same principle of a ring-shaped encirclement or stabilisation. In medical letters or reports, it is often stated which type of cerclage was used, for example "McDonald cerclage" or "Shirodkar cerclage". These are different techniques that differ mainly in the way the thread is guided and positioned.

In summary

Cerclages are special stitches or bands used to stabilise tissue or bone. They are most commonly used on the cervix during pregnancy to help prevent premature birth. The decision to use a cerclage is made individually and considered carefully. Anyone who reads this term in a medical letter can be sure that it refers to a stabilising measure, either as a precaution or to treat an existing problem. If you are unsure about anything, speaking with your treating doctor is always the best step. Those who would like to know more about the cervix can find further information on the cervix uteri.