Cerclage

Cerclage ( cerclage of the cervix ) is the name of an operation that solves the incompetence (insufficiency, i.e. broken closing function) of the cervix in the second and at the beginning of the third trimester of pregnancy. The frequency of this performance has decreased significantly in recent years.

Diagnosis of incompetence

 * Analysis of gestational history - spontaneous abortions after the 12th week of pregnancy, premature births.
 * A palpable finding in the cervix.
 * Transvaginal ultrasound examination mainly showing insufficiency of the internal portal.
 * Cervicometry determining the length of the cervix.

Performance indication

 * Reoccurring (habitual) miscarriage caused by cervical incompetence.
 * Detection of an unclosed cervix in the indicated time range of pregnancy - the prognosis of the procedure is worse in proportion to the advancedness of the finding on the throat and the timeliness of the appearance of this serious finding.
 * As a preventive measure, it is sometimes indicated in multiple pregnancies, especially from triplets and above.

The performance itself
Cerclage is performed no earlier than the 12th week of pregnancy. For repeated miscarriages it can be done sooner, but only up to the completed 26th week of pregnancy. Before the procedure, it is necessary to calm the uterine activity and intensively treat the identified vaginal infection.

Terms
The basic conditions are:
 * vital undamaged fetus
 * exclusion of other causes of miscarriage

Contraindications

 * bleeding
 * drained amniotic fluid
 * intraovular infection
 * uncontrollable uterine contractions

Performance technique
The performance technique is quite simple. After stopping the cervix in the vaginal mirrors and disinfecting the vagina, a circular submucosal suture is performed in the vaginal vaults with one of the doubled non-absorbable fibers. The bladder area must be avoided in the anterior vault. After a slight tightening, it becomes knotted in the lateral vaginal vault. The suture is left in situ until the 28th week of pregnancy. It must be released sooner if its cutting through or in the case of occuring complications that cerclage contraindicates.

Performance complications
Sometimes the scar after the cerclage during childbirth is the cause of the anatomical rigidity of the goal.