Cervical Cerclage (Cervical Stitch): A Complete UK Guide
What Is a Cervical Cerclage?
A cervical cerclage, commonly known as a cervical stitch, is a surgical procedure in which a strong suture is placed around the cervix (the neck of the womb) to keep it closed during pregnancy. It is offered to women at risk of cervical insufficiency (sometimes called an incompetent cervix), a condition in which the cervix opens too early without the usual signs of labour, often leading to second-trimester pregnancy loss.
In the UK, the procedure is performed in specialist fetal medicine or obstetric units and is relatively uncommon, affecting only a small proportion of pregnancies.
Who Might Need a Cerclage?
A cerclage may be recommended in several situations:
1. History-Indicated (Prophylactic) Cerclage
Offered if you have had one or more second-trimester losses previously, particularly if the cervix opened painlessly without contractions. Usually placed at 12-14 weeks of pregnancy.
2. Ultrasound-Indicated Cerclage
If routine scans show your cervix shortening (below 25mm) before 24 weeks, especially if you have a previous history of premature birth. Serial scans monitor cervical length from around 16 weeks.
3. Rescue (Emergency) Cerclage
Placed as an emergency if the cervix is found to be already opening or membranes are bulging, usually between 16 and 24 weeks. This carries higher risks but may save the pregnancy.
Types of Cerclage Procedure
- Transvaginal (McDonald) - a stitch is placed around the cervix in a purse-string fashion. Most common and least invasive. Usually removed at 37 weeks to allow labour to begin.
- Transvaginal (Shirodkar) - similar to McDonald but involves slightly more dissection near the bladder. Less commonly used in the UK.
- Transabdominal - the stitch is placed around the cervix from inside the abdomen via keyhole or open surgery. Used when previous vaginal stitches have failed. Requires a caesarean section for delivery and the stitch may be left in for future pregnancies.
What the Procedure Involves
Most transvaginal cerclages are performed under spinal or general anaesthetic as a day case. You will:
- Have bloods taken and an IV cannula placed
- Receive antibiotics to prevent infection
- Be positioned as for a smear test
- Have the stitch inserted vaginally - usually taking 15-30 minutes
- Be monitored for a few hours before going home
Transabdominal cerclage requires a longer hospital stay and general anaesthetic.
Recovery and Aftercare
After a vaginal cerclage, you will be advised to:
- Rest for 2-3 days, avoiding heavy lifting and exercise
- Avoid sexual intercourse until cleared by your consultant
- Avoid swimming and baths for 2 weeks (showers are fine)
- Monitor for bleeding, infection or rupture of membranes
- Attend all scheduled scans to check cervical length
You may be prescribed progesterone supplements alongside the stitch, as there is evidence the two approaches work synergistically to prevent preterm birth.
Risks of Cervical Cerclage
While generally safe, cerclage carries some risks:
- Infection - managed with antibiotics
- Premature rupture of membranes (PROM)
- Bleeding during or after the procedure
- Preterm labour triggered by the stitch
- Cervical trauma during stitch removal
- Small increased risk of caesarean delivery
Your consultant will weigh these against the risk of losing the pregnancy without the stitch.
Cervical cerclage is a well-established, often life-changing intervention for women at risk of cervical insufficiency. While it is not without risks, for carefully selected patients it significantly improves the chance of carrying a baby to a healthy gestation. With expert NHS care, thorough monitoring and strong emotional support, most women with a cerclage go on to deliver healthy babies.