Incompetent cervix-stitch Treatment

What is Incompetent cervix-stitch?

When a woman’s cervix is weak (incompetent cervix), there is a strong possibility that the baby may be born prematurely because the cervix shortens or opens too early. In order to prevent premature labor, the doctor may recommend cervical cerclage. A cerclage is used to prevent premature labor in the woman. A closed cervix helps a developing baby to stay inside the uterus until the mother reaches 37-38 weeks of pregnancy. Cervical cerclage refers to a variety of procedures, in this procedures sutures or synthetic tape are used to reinforce the cervix during pregnancy in women, who have a history of a short cervix. The cervix, the lower part of the uterus opens to the vagina. Cervical cerclage can be done through the vagina or, less commonly, through the abdomen.

The woman’s health care provider might recommend cervical cerclage if her cervix is at risk of opening before the baby is ready to be born or, in some cases, if her cervix begins to open too early. However, cervical cerclage isn't suitable for everyone; it can cause serious side effects and doesn't always work. Some women might experience preterm labor if they have a cerclage placed for a short cervix.

Why it’s done?

The cervix is closed, long and firm before the pregnancy. During pregnancy, the cervix gradually softens, decreases in length and opens up for the preparation of birth. If the patient has an incompetent or short cervix, this may result in the opening of the cervix too soon. This may result in pregnancy loss or giving birth prematurely.​

The woman’s health care provider might recommend cervical cerclage during pregnancy to prevent premature birth if she has:

• History of second-trimester pregnancy loss which is related to painless cervical dilation in the absence of labor or placental abruption
• Prior cerclage because of the  painless cervical dilation in the second trimester
• During the second-trimester, painless cervical dilation is being diagnosed
• A short cervical length before 24 weeks of pregnancy, in a singleton pregnancy

Cervical cerclage isn't suitable for everyone at risk of premature birth. The health care provider might not recommend a cervical cerclage if the patient has:

• Active vaginal bleeding
• Active preterm labor
• An intrauterine infection
• Preterm premature rupture of membranes: When the fluid-filled membrane that surrounds and cushions the baby during the pregnancy (amniotic sac) breaks or leaks before week 37 of the pregnancy
• Twin or higher order of pregnancy
• A fetal anomaly which is not compatible with life
• Prolapsed fetal membranes: A condition in which the amniotic sac extends through the opening of the cervix

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When it is not recommended?

Even if the cervix starts to widen too early, the cervical stitch may not be the right option for the patient if she also has any of the following:

• Preterm labor
• Vaginal bleeding
• An infection in the uterus
• The amniotic sac(the bag of waters) leaks or breaks before 37 weeks of pregnancy
• The amniotic sac bulges through the cervix

Cervical stitch is recommended only if the mother is pregnant with one baby.

Symptoms of Incompetent Cervix

Incompetent Cervix, also called cervical insufficiency, is a condition in which the cervix starts to dilate and thin, during pregnancy. This can lead to miscarriage or preterm birth. Pregnant women with this condition can even experience lifestyle changes due to pregnancy complications. While it is most common in the second trimester, it can begin earlier, even in the first trimester for some women.

Common Symptoms of Incompetent Cervix:

• Painless Cervical Dilation
• Vaginal Discharge
• Pelvic Pressure
• Back Pain
• Spotting or Bleeding
• Preterm Labor
• Pain or Cramping

What are the risks involved?

 Risks due to cervical cerclage may include:

• Inflammation in the fetal membranes can occur due to a bacterial infection
• Vaginal bleeding
• A tear in the cervix
• Preterm premature rupture of the membranes: When the fluid-filled membrane that surrounds and cushions the baby during pregnancy leaks or breaks before week 37 of pregnancy
• Suture displacement

After receiving a cervical cerclage, the woman must contact her health care provider immediately if she experiences a leakage of fluid from her vagina, a sign of preterm premature rupture of membranes. The cervical cerclage may be removed early if the patient has preterm premature rupture of membranes or if she has symptoms that suggest that she has a uterine infection.

Cause of Incompetent Cervix

The cause of incompetent cervix (also referred to as cervical insufficiency) may be varied and therefore may have more than one underlying cause. The cause is often not clear, although there are likely risk factors in association with cervical insufficiency.

Some of the common conditions that may predispose a woman to cervical insufficiency include:

• Previous Cervical Trauma or Surgery
• Congenital Conditions
• Multiple Pregnancies
• Infections
• Connective Tissue Disorders
• Hormonal Imbalances
• Excessive Stretching of the Cervix
• Inherited Genetic Factors
• Short Cervix

Facilities and Services offered for International Patients for Incompetent Cervix Surgery Treatment

Many healthcare facilities make provisions for these international patients that come looking for incompetent cervix surgery treatment, also known as cervical cerclage.

Here are some of the common facilities and services provided for international patients:

• Dedicated International Patient Support
• Pre-Arrival Assistance
• Personalized Care and Medical Services
• State-of-the-Art Facilities and Equipments
• Post-Procedure Care and Monitoring
• Accommodation and Comfort Services for Patients and Family
• Remote Follow-up and Telemedicine Services
• Patient Education and Support Programs
• Emergency Support and Critical Care

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Pre-Treatment Process of Incompetent Cervix Surgery

Cervical cerclage treatment is a surgery that aims at treating an incompetent cervical and its preparation allows for safe surgery or procedure to be done.

Here’s an overview of the steps involved in the pre-treatment process:

• Medical Evaluation and History
• Physical Examination
• Diagnostic Tests
• Patient Education and Counselling
• Timing and Scheduling of Cerclage
• Planning for Anaesthesia
• Preparation for Hospital Admission

Diagnostic Tests for Incompetent Cervix Surgery

In case where a cervical cerclage treatment, or an incompetent cervix stitch treatment, is to be performed, several investigations are carried out to assess the condition of the cervix and to determine the advisability and safety of the procedure. These tests are useful to make sure you have cervical insufficiency and to also determine your risk of premature delivery. Here are the main diagnostic tests involved in the pre-procedure process:

• Transvaginal Ultrasound
• Pelvic Examination
• Fetal Ultrasound
• Infection Screening
• Amniocentesis (if indicated)
• Blood Tests
• Urine Test

What does the procedure involve?

During the procedure

During transvaginal cervical cerclage, the woman’s health care provider will insert a speculum into her vagina and grasp the cervix with the help of ring forceps. Use of ultrasound might be required for guidance. The woman’s health care provider will use either the McDonald operation or the Shirodkar operation. There is no significant difference in outcomes between the two methods.

During the McDonald operation, the health care provider will use a needle to put stitches around the outside of her cervix. Next, the ends of the sutures will be tied close to the cervix.
During the Shirodkar operation, the health care provider will pull the cervix toward him /her while pulling back the side walls of the vagina with the help of ring forceps. Next, he or she will make small incisions in the cervix where it meets vaginal tissue. Then, the mother’s cervix is closed with help of a needle which passes through the incisions and the cervix is tied. Stitches might use to reposition the vaginal tissues which are affected by the incisions.

During transabdominal cervical cerclage, an abdominal incision will be made by the health care provider. The woman’s health care provider might elevate uterus to gain better access to the cervix. Then, the mother’s cervix is closed with help of a needle to place tape around the narrow passage connecting the lower part of the uterus to the cervix and thus the cervix is tied. Then he /she will set the uterus back into its place and the incision is being closed. This procedure also can be done laparoscopically.

What Can I Expect After The Procedure?

• The patient may have to stay in the hospital for a few hours or overnight to be monitored for premature contractions or labor.
• Immediately after the procedure, the patient may experience light bleeding and mild cramping, which should stop after a few days. This may be followed by an increased thick vaginal discharge and continues for the remainder of her pregnancy.
• The patient may receive medication for preventing infection or preterm labor.
• For 2-3 days after the procedure, the patient must avoid any unnecessary physical activity.
• The doctor will discuss with the patient when she could resume regular activities.
• Abstinence from sexual intercourse is usually recommended for one week before and at least one week after the procedure.

Success Rate of Incompetent Cervix-Stitch Treatment

It has been found that over 80-90% of women who undergo preventive cerclage for a history of cervical cerclage benefitted from the procedure, the number of weeks gained and the risk of preterm birth lowered whereas in cases of emergency cerclage it has a success rate slightly lesser than the first.

Best Hospitals for Incompetent Cervix-Stitch Treatment

• Fortis Memorial Research Institute, Gurgaon
• Medanta The Medicity, Gurgaon
• Artemis Hospital, Gurgaon
• Max Hospital, Saket, New Delhi
• Apollo Hospital, New Delhi

Best Doctors for Incompetent Cervix-Stitch Treatment

• Dr. Mamta Pattnayak
• Dr. Preeti Rastogi
• Dr. Renu Raina Sehgal
• Dr. Anuradha Kapur
• Dr. Madhu Roy

Why Choose GetWellGo for Incompetent Cervix-Stitch Treatment?

Selecting a healthcare provider for incompetent cervix surgery treatment or cervical insufficiency treatment is never easy, and that is why GetWellGo has been outstanding in Providence to ensure safety, compassionate, and quality care. Here are some reasons why many may consider GetWellGo for incompetent cervix surgery treatment:

• Experienced Medical Professionals
• Confidential and Private Care
• Comprehensive Abortion Options
• Advanced Facilities and Safety Protocols
• Follow-up and After-Care Services
• Transparency and Affordability
• Medical Visa Assistance
• Travel and Accommodation
• Multilingual Support

Conclusion

Incompetent cervix stitch treatment also known as cervical insufficiency treatment is widely recommended for women experiencing cervical insufficiency where the cervix begins to dilate early, thus increasing likelihood of pregnancy complications or preterm labor. They offer mechanical support to the cervix, thereby helping to keep it healthy throughout pregnancy and ensuring the pregnancy is full term. Cervical cerclage treatment on the other hand is an individual treatment program that is provided according to a patient’s history in addition to cervical dimensions and pregnancy status. It’s relatively safe and its side effects include infection and preterm labour which are prevented by early intervention after the procedure.

FAQs

1. When the stitch is done?

• A cervical stitch is usually done when the woman is between 12 and 14 weeks pregnant. 

2. How long does it stay in?

• Stitch is normally retained till about 37 weeks of pregnancy; however, it may be removed earlier if there is commencement of contractions or rupture of membranes. 

3. How will it be like after the procedure?

• The typical symptoms include mild vaginal bleeding and uterine contractions for the first few days, and a heavy, white, creamy, or pale yellow vaginal discharge for the remainder of pregnancy. Your doctor will tell you that you should avoid heavy exercise and sexual activity for approximately 10 days, and you should plan to have a week or more off work. 

4. What if you are in labor with this stitch on?

• It is possible that cervix may suffer injury during the process of labor.

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