Pregnancy and Childbirth: Transvaginal Cerclage

Your healthcare provider suggests that you have a cerclage. This procedure closes the cervix during a pregnancy. It is done to help prevent miscarriage if it's because of cervical incompetence, or premature birth. Miscarriage is loss of a fetus early in pregnancy. Premature birth is delivery before the 37th week. Transvaginal cerclage involves reaching the cervix through the vagina to stitch it closed. Read on to learn more.

Cross section side view of woman's pelvis showing baby developing in uterus. Line shows where sutures are placed to hold cervix closed.

The cervix and pregnancy

The uterus (womb) is where the baby grows during pregnancy. The cervix is the opening from the uterus into the vagina. The cervix normally remains firmly closed until the baby is ready to be born. A short or weakened cervix may not be able to stay closed as the baby grows larger. This is called cervical insufficiency or cervical incompetence. If the cervix fails and opens too soon, miscarriage or premature birth may result.

How cervical cerclage works

The goal of a cerclage is to hold the cervix closed. This allows the baby to fully develop before leaving the womb. The healthcare provider stitches the cervix closed at about week 12 of the pregnancy. At week 37, the baby should be ready for life outside the womb. So the healthcare provider removes the stitch. This allows the cervix to open when labor begins. Once you have a cerclage, you will likely have one in future pregnancies.

Risks and possible complications of transvaginal cerclage

The procedure is considered safe. But like all procedures, it carries some risks. These include the following:

  • Infection

  • Premature contractions

  • Premature labor

  • Premature delivery

  • Premature rupture of membranes

  • Pregnancy loss

  • Tearing or rupture of the cervix if labor begins before the stitch is removed

  • Injury to bladder

  • Risks of anesthesia

Preparing for the procedure

How to get ready for the procedure:

  • Tell your healthcare provider about all medicines you take. This includes over-the-counter medicines like vitamins and pain medicines.

  • Do not put anything in your vagina for 24 hours before the procedure. This includes having intercourse.

  • If instructed, do not eat or drink anything (including water) after the midnight the night before the procedure. (If you have diabetes, ask your healthcare provider whether you need special preparations.)

The day of the procedure

Here is what to expect on the day of the procedure:

  • Just before the procedure begins, an intravenous (IV) line is placed in your hand or arm. It delivers fluids and medicine into the body.

  • You will be given anesthesia. This is medicine to keep you free of pain during the procedure. Depending on what type you are given, you may be relaxed, drowsy, or fully asleep during the procedure. If you are given spinal anesthesia, you will be numb from the waist down.

  • During the procedure:

    • A speculum will be put into your vagina to hold it open.

    • Local anesthesia may be injected into the cervix to numb it.

    • The healthcare provider uses instruments through the vagina to stitch the cervix closed. Surgical thread is used. Knots are made to hold the thread tight until it is cut later in your pregnancy. In many cases, the thread is wrapped around the cervix and pulled tight.

After the procedure

Here is what to expect after the procedure:

  • You will be taken to a room where you’ll recover from the anesthesia. Nurses will check on you as you rest.

  • You will be watched for signs of premature labor. You will also be given medicine that helps prevent premature labor.

  • Your baby’s heart rate will be monitored.

  • You will have some light bleeding and cramping. This is normal. You will likely be given pain medicine. If you are still in pain, tell the nurse.

  • You may be able to go home later that day. Or you may stay overnight in a hospital room to be sure you do not go into premature labor. When you leave the hospital, have an adult friend or family member drive you home.

Recovering at home

Tips for home recovery include:

  • You may be prescribed medicine to take at home. This may be medicine to relieve pain. It may also be medicine to prevent labor. Take all medicines as prescribed.

  • Take it easy for 2 to 3 days after the procedure. Plan to have others help you as needed. Unless you are instructed to do so, you do not need to stay in bed.

  • Avoid having intercourse for at least 7 days after the procedure.

  • Ask your healthcare provider when you can return to work and exercise.

Follow-up care

During your follow-up visit, your healthcare provider will check your healing. You can also discuss how your pregnancy is progressing. You will be told when to schedule an appointment to have the stitch removed.

When to call the healthcare provider

Call your healthcare provider if you notice any of the following:

  • A fever of 100.4°F (38°C) or higher

  • Pain that does not go away even after taking pain medicine

  • Contractions or stomach cramping

  • Fluid leaking from the vagina

  • Bleeding or spotting of blood from the vagina

  • Foul-smelling drainage from the vagina

  • Back or stomach pain