Why you may need a cervical cerclage
Recurrent mid trimester miscarriages are usually due to cervical incompetence. This is a common cause of recurrent miscarriage and can be diagnosed in several ways.
Hysterosalpingogram done at an appropriate time in the menstrual cycle will show radiographic evidence of widening of the cervical canal.
Also, easy passage of at least a 6mm Hegar dilator through the internal os of the cervix is evidence of cervical incompetence. In pregnancy, a shortening and widening of the cervical canal can be detected at a vaginal examination and also by ultrasonography.
The management of incompetent cervix still remains controversial but the usual treatment is a the placement of a special, non absorbable suture(mersilene tape), which is inserted encircling the cervix at the level of the internal os. This treatment modality for cervical incompetence and recurrent miscarriages is known as cervical cerclage.
Two techniques for cervical cerclage are described; in the McDonald’s technique, the mersilene tape is inserted like a purse string at the level of the internal is while in the Shirodkar method, the suture is inserted under the cervical skin at the level of the internal os after some dissection.
Cerclage is done in the theatre under local anaesthesia by an Obstetrics and Gynecology doctor. It is a day procedure. You can go home same day after the procedure or the following day as your doctor deems appropriate.
The common complications of cervical cerclage are pain, bleeding(though mild), infection, premature labour, and failure of the procedure.
The timing of cerclage is usually around the the 14 weeks of gestation to prevent miscarriage. The cerclage or tape is removed at 38 weeks of pregnancy or at the onset of labour or at the time of Caesarean section.
COST OF CERVICAL CERCLAGE
It is affordable. The cost of cerclage is around #25,000 – #30,000 Naira. In University of Benin Teaching Hospital, cerclage is #28,000 Naira.
Price/Cost of Mersilene Tape
Mersilene tape is the suture used for the cerclage procedure. It is not like the usual thin and finely threaded sutures you find around. It is normally flat and most times white. In Nigeria, the price of mersilene tape is between N6,000 to N9,000 Naira. It is available in many medical supplies stores in Nigeria.
Cervical cerclage removal
According to Mayoclinic, a transvaginal cervical cerclage is typically removed at around week 36 to 37 of pregnancy — or at the start of preterm labor.
A McDonald cerclage can usually be removed in a health care provider’s office without anesthetic, while a Shirodkar cerclage might need to be removed in a hospital or surgery center. After having a transvaginal cervical cerclage removed, you’ll typically be able to resume your usual activities as you wait for labor to begin naturally.
If you expect to have a C-section and plan to have children in the future, you might choose to leave a Shirodkar cerclage in place throughout your pregnancy and after the baby is born. However, it’s possible that the cerclage could affect your future fertility. Consult your health care provider about your options.
If you had a transabdominal cervical cerclage, you’ll need to have another abdominal incision to remove the cerclage. As a result, a C-section is typically recommended. Your baby will be delivered through an incision made above the cerclage. During the C-section, you can choose to have the cerclage removed or leave it in place for future pregnancies.
Other common causes of miscarriage apart from cervical incompetence are genetic defects, uterine abnormalities, hormonal imbalance, ABO blood group incompatibility, Rhesus incompatibility, and chronic maternal diseases like diabetes, HIV and hypertension .
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