Types of Cerclage

A cerclage is a surgical procedure that is performed on pregnant women who are suffering from cervical incompetence, or a weak cervix. When the cervix is not strong enough to hold a growing fetus, it can be reinforced and held closed with a strong stitch. There are five types of cerclage, each used to prevent premature labor.

  1. McDonald Stitch

    • The most common type of cerclage used in the United States today, this procedure involves a stitch that weaves in and out of the cervix, allowing it to be pulled closed like a drawstring bag. Women with McDonald stitch cerclages can have vaginal deliveries.

    Shirodkar Stitch

    • The first of its kind, the Shirodkar stitch is placed high in a woman's cervix, close to the uterus. In its original form, the Shirodkar stitch was non-dissolvable and intended for permanent placement. Advances in science have allowed for this stitch to be removed at a medical caregiver's discretion; women with Shirodkar stitches may give birth vaginally or via cesarean section.

    Abdominal Stitch

    • When a cervix is short or damaged and there is not enough tissue to maneuver through cerclage, an abdominal stitch is used. This permanent procedure is performed through an incision on a woman's abdomen and connects the upper and lower parts of the cervix together. Women who have this type of cerclage must deliver via cesarean.

    Hefner-Wurm Cerclage

    • Used later in a pregnancy, this emergency procedure is a remedy to a dilated cervix from which the fetus's membranes, or bag of waters, is starting to emerge. The Hefner-Wurm cerclage utilizes a U-shaped or "mattress" stitch that works well with minimal cervical tissue. The stitch can be removed prior to childbirth, allowing for a vaginal delivery.

    Lash Cerclage

    • The only cerclage performed prior to pregnancy, this preemptive procedure is used on women with anatomical defects or significant trauma to the cervix. The lash cerclage is a permanent procedure that requires women to deliver via cesarean section.

    Alternatives to Cerclage

    • When cerclage is not an option, there are treatments and medications that can be effective in preventing pre-term delivery or minimizing the risk to the fetus and/or mother. In some cases, bed rest and the consumption of adequate fluids is sufficient to stop premature contractions and reduce the risk of early labor. Medications administered through injection, or intravenously, are sometimes used to temporarily halt labor contractions.

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