Background Information:

What are the other Names for the Procedure?

• Cervical Encirclage
• Cervical Stitch

What is Cervical Cerclage surgical procedure?

Cervical Cerclage is a surgical procedure in which a stitch or a band is placed around the cervix to help prevent premature opening (dilation) of the cervix during pregnancy.

What part of the Body does the Procedure involve?

Cervical Cerclage procedure involves the cervix, the lower part of the uterus that opens into the vagina.

Why is the Cervical Cerclage surgical procedure Performed?

Cervical Cerclage is usually performed to help prevent premature delivery or miscarriage due to cervical incompetence, a condition where the cervix opens too early in pregnancy.

What are some Alternative Choices for the Procedure?

Alternative choices to Cervical Cerclage may include the following:

• Adequate bed rest
• Medication to reduce contractions and progesterone supplements

However, these alternatives may not be as effective as Cervical Cerclage in preventing premature delivery.

What are the Recent Advances in the Procedure?

Recent advances in Cervical Cerclage include the use of laparoscopic or robotic-assisted techniques for placement of the cerclage, which may result in less pain and faster recovery compared to traditional abdominal cerclage.

What is the Cost of performing the Cervical Cerclage surgical procedure?

The cost of Cervical Cerclage can vary depending on factors such as the location of the healthcare facility and whether the procedure is performed on an outpatient or inpatient basis. It is important to check with your insurance provider to determine your coverage. In many cases, an estimate may be provided before the procedure.

The cost of the Cervical Cerclage procedure depends on a variety of factors, such as the type of your health insurance, annual deductibles, co-pay requirements, out-of-network and in-network of your healthcare providers and healthcare facilities. The final amount depends upon the findings during the surgery/procedure and post-operative care that may be needed.

When do you need a Second Opinion, prior to the Procedure?

• It is normal for a patient to feel uncomfortable and confused with a sudden inflow of information regarding the Cervical Cerclage procedure and what needs to be done
• If the patient needs further reassurance or a second opinion, a physician will almost always assist in recommending another physician
• Also, if the procedure involves multiple steps or has many alternatives, the patient may take a second opinion to understand and choose the best one. They can also choose to approach another physician independently

What are some Helpful Resources?

American College of Obstetricians and Gynecologists (ACOG) - https://www.acog.org/

March of Dimes - https://www.marchofdimes.org/

National Institute of Child Health and Human Development (NICHD) - https://www.nichd.nih.gov/

Society for Maternal-Fetal Medicine (SMFM) - https://www.smfm.org/

Prior to Cervical Cerclage surgical procedure:

How is the Cervical Cerclage surgical procedure Performed?

The Cervical Cerclage procedure is performed in the following manner:

• It is typically performed using regional or general anesthesia
• A stitch or a band is placed around the cervix to hold it closed, and the stitch or band is usually removed near the end of the pregnancy

Where is the Procedure Performed?

Cervical Cerclage is typically performed in a hospital or outpatient surgery center.

Who Performs the Procedure?

Cervical Cerclage is typically performed by an obstetrician, gynecologist, or maternal-fetal medicine specialist.

How long will the Procedure take?

• The length of the Cervical Cerclage procedure can vary depending on factors such as the technique used and the experience of the surgeon
• However, it typically takes between 30 minutes to an hour

What do you need to tell your Physician before the Procedure?

It is very important to provide the following information to your healthcare provider. This enables the healthcare provider to assess the risks of the procedure and helps avoid complications.

• Before the Cervical Cerclage procedure, it is important to inform your physician about any medical conditions you have
• Provide medical history such as diabetes, hypertension, heart disease, etc. (if any)
• Provide a complete list of medications you are currently taking to your physician. This information is useful for a variety of reasons. For example, it can help your healthcare provider prevent complications due to a drug interaction
• If you are allergic to any specific medication or food items
• If you are taking blood thinners, such as aspirin, warfarin, herbal supplements, or any other such medications
• Any medical or family history of bleeding disorders or blood clots
• If you have ever been diagnosed with blood clots in your leg (deep vein thrombosis) or lung (embolism of lung)
• Any unusual effects of anesthesia from prior surgery
• If you have a history of frequent bone fractures (this may affect bone-healing, if bones are involved as part of your procedure)
• A list of all previous surgical procedures you have undergone, like for example - removal of appendix, gallbladder, or any other part, of your body; surgical repair of any body part, such as hernia repair, perforation of bowel wall, etc.
• Information about any implanted electronic medical devices such as pacemakers, defibrillators, pain control devices, or deep brain stimulators for Parkinson’s disease or seizures
• Any joint implants, and if the surgeon who implanted them recommends preoperative antibiotics

What Preparations are needed, prior to the Procedure?

• Before Cervical Cerclage, you may be advised to avoid eating or drinking for a certain period of time
• And you may need certain tests or evaluations to ensure you are a good candidate for the procedure

What is the Consent Process before the Procedure?

The physician will obtain permission for the Cervical Cerclage procedure using an Informed Consent Form.

Consent for the Procedure: A “consent” is the approval to undergo a procedure. A consent form is signed after the risks and benefits of the procedure, and alternative treatment options, are discussed. This process is called informed consent.

In case of minors and individuals unable to give informed consent, the parent or legal guardian or next of kin can sign the consent for the procedure.

What Tests are needed, before the Cervical Cerclage surgical procedure?

Before Cervical Cerclage, you may need to undergo certain tests or evaluations to assess your overall health and determine whether you are a good candidate for the procedure. These may include the following:

• Blood tests
• Imaging studies
• Fetal monitoring

What are some Questions for your Physician?

Some of the questions that you might ask your healthcare provider are as follows:

• What is a Cervical Cerclage procedure?
• Why is this procedure necessary? How will it help?
• How soon should I get it done? Is it an emergency?
• Who are the medical personnel involved in this procedure?
• Where is the procedure performed? 
• What are the risks while performing the procedure?
• What are the complications that might take place during recovery?
• How long will the procedure take?
• How long will it take to recover? When can I resume normal work?
• How many such procedures have you (the physician) performed?
• Are any follow-up tests or periodic visits to the healthcare facility required after the procedure?
• What are the costs involved?

During the Cervical Cerclage surgical procedure:

What kind of Anesthesia is given during the Procedure?

Cervical Cerclage is typically performed using regional or general anesthesia, which helps to minimize pain and discomfort during the procedure.

How much Blood will you lose, during the Procedure?

Blood loss during Cervical Cerclage is typically minimal, but some bleeding or spotting may occur after the procedure.

What are the possible Risks and Complications during the Cervical Cerclage surgical procedure?

There are general factors that increase one’s risk of getting complications during the Cervical Cerclage procedure, which include:

• Obesity: Generally, the greater the degree of obesity, the greater the surgical risk
• Smoking: The longer the smoking history (in pack years smoked), the greater the surgical risk
• Advancing age
• Poorly-controlled diabetes, as evidenced by a high hemoglobin A1c and a high fasting glucose
• Poorly-functioning kidney, as evidenced by increased BUN (blood urea nitrogen) and blood creatinine
• Poorly-functioning liver, as evidenced by increased blood liver function tests
• Hypertension (increased blood pressure), especially if it is poorly controlled
• Poor nutritional status (malnutrition with mineral and vitamin deficiencies)
• Poor lung function, as evidenced by abnormal lung function tests
• History of bleeding disorders
• Poor immune system due to a variety of causes

Some of the possible risks and complications that may arise during a Cervical Cerclage procedure include:

• Bleeding
• Infection
• Rupture of the amniotic sac
• Injury to the neighboring structures

Please note that the complications and risks arising during the procedure are additionally governed by factors such as prior significant health issues.

What Post-Operative Care is needed at the Healthcare Facility after the Cervical Cerclage surgical procedure?

• Post-procedure, the patient may be advised to stay in the hospital for a period of time for observation and monitoring
• Antibiotics and/or other medications to prevent infection or reduce the risk of preterm labor may be administered

After the Cervical Cerclage surgical procedure:

What are the possible Risks and Complications after the Cervical Cerclage surgical procedure?

Cervical Cerclage is generally a safe procedure, but rare complications may include:

• Bleeding
• Infection
• Preterm labor 
• Difficulty with cervical dilation during labor

What is the Prognosis after the Surgery?

• The prognosis after Cervical Cerclage is generally good, with a high rate of successful pregnancies and minimal complications
• However, the success of the procedure can depend on factors such as the timing of the procedure and the severity of cervical incompetence

When do you need to call your Physician?

Do contact your physician or call 911 (or your local emergency number) based on the seriousness of any of the following symptoms:

• Fever and chills
• Vaginal discharge
• If any bleeding is experienced
• Cramping
• Presence of any unusual symptoms

What Post-Operative Care is needed at Home after the Cervical Cerclage surgical procedure?

• After Cervical Cerclage, adequate rest and avoidance of strenuous activity for a period of time are advised
• Monitor symptoms and report any changes to the physician

It is recommended to contact the concerned healthcare provider if there are any questions regarding one’s care.

How long does it normally take to fully recover, from the Procedure?

Recovery time after Cervical Cerclage can vary depending on the technique used and the individual's overall health. However, most patients can return to normal activities within a few days to weeks.

Additional Information:

What happens to tissue (if any), taken out during the Procedure?

• Any tissue or samples taken during the Cervical Cerclage procedure may be sent for laboratory analysis to help diagnose any underlying conditions or identify any potential complications
• Following lab analysis, the samples are later disposed of as per the standard medical procedure

When should you expect results from the pathologist regarding tissue taken out, during the Procedure?

• The samples/tissue is processed in the laboratory under a pathologist's supervision
• Slide(s) are prepared once the tissue is processed and this is examined by a pathologist, and a pathology report issued
• Depending on the complexity of the case, the issue of the report may take anywhere between 4-24 hours

Who will you receive a Bill from after the Cervical Cerclage surgical procedure?

It is important to note that the number of bills that the patient may receive depends on the arrangement the healthcare facility has with the physician and other healthcare providers.

Sometimes, the patient may get a single bill that includes the healthcare facility, and the consultant physician charges. Sometimes, the patient might get multiple bills depending on the healthcare provider involved. For instance, the patient may get a bill from:

• The outpatient surgical center or hospital
• The concerned healthcare provider(s) including an obstetrician, gynecologist, or maternal-fetal medicine specialist
• A pathologist (if samples are sent out for lab analysis)
• The laboratory at which the specimens are processed

The patient is advised to inquire and confirm the type of billing before the Cervical Cerclage procedure is performed.