Cerclage is a surgical procedure used to prevent pregnancy loss from a weakened cervix. The technical term for this is cervical insufficiency or incompetent cervix. This problem leads to early dilation and delivery, at less than 24 weeks of pregnancy. Incompetent cervix may be discovered during a routine ultrasound evaluation when the cervical length is measured. However, many patients who need a cerclage unfortunately have previously suffered a stillbirth due to their cervical insufficiency.
Cervical insufficiency can be treated very successfully with cervical cerclage in the late first trimester. Most patients can undergo an out-patient procedure called a vaginal cerclage. There are several techniques: The McDonald (purse string) and the Shirodkar technique, which allows the stitch to be placed higher on the cervix. The latter technique leaves a larger portion of the closed cervix below the cerclage.
There are patients who have special circumstances which require a transabdominal cerclage. This is an in-patient procedure that uses an abdominal incision similar to the one made for a cesarean section. A type of surgical suture called a Mersilene band is placed around the cervix where it meets the uterus, at the highest point possible.
Transabdominal cerclage is reserved for patients who have a very shortened cervix, which has been damaged during prior child birth or from prior surgeries. This procedure is also appropriate for patients who have had a poor outcome with a vaginal cerclage. We have performed several transabdominal cerclages on patients with prior radical vaginal trachelectomy for cervical cancer.
Transabdominal cerclage is a very technical procedure that should only be performed by experienced surgeons. Dr. Balderston has been performing these since 1998 with a successful pregnancy outcome in well over 90%. Very few patients should need a transabdominal cerclage, as many can have successful pregnancies with a transvaginal Shirodkar approach.
Dr. Balderston performed transabdominal cerclage with Dr. Novy at OHSU for four years prior to Dr. Novy retiring. He was one of the earliest pioneers with transabdominal cerclage and perfected the technique that has drastically decreased the risks with this procedure.
Patients who have a transabdominal cerclage will require a cesarean section for delivery. The cerclage can be left in place after delivery for protection in future pregnancies as it does not affect the mother.