A surgical method for closing an incompetent cervix during pregnancy to prevent premature delivery. A stitch is placed around the cervix, or opening between the uterus and vaginal tract, to keep it closed during pregnancy. This is only needed in cases where a woman has a diagnosis of cervical incompetence.
- A McDonald cerclage, described in 1957 is the most common, and is essentially a pursestring stitch used to cinch the cervix shut; the cervix stitching involves a band of suture at the upper part of the cervix while the lower part has already started to efface. This cerclage is usually placed between 12 weeks and 24 weeks of pregnancy. The stitch is generally removed around the 37th week of gestation.
- A Shirodkar cerclage is very similar, but the sutures pass through the walls of the cervix so they’re not exposed. This type of cerclage is less common and technically more difficult than a McDonald, and is thought (though not proven) to reduce the risk of infection. The Shirodkar procedure sometimes involves a permanent stitch around the cervix which will not be removed and therefore a Caesarean section will be necessary to deliver the baby. The Shirodkar technique was first described by Dr. V. N. Shirodkar in Bombay in 1955. In 1963, Dr. Shirodkar traveled to NYC to perform the procedure at the New York Hospital of Special Surgery; the procedure was successful, and the baby lived to adulthood.
- An abdominal cerclage, the least common type, is permanent and involves stitching at the very top of the cervix, inside the abdomen. This is usually only done if the cervix is too short to attempt a standard cerclage, or if a vaginal cerclage has failed or is not possible. However, a few doctors (namely Dr. Arthur Haney at the University of Chicago and Dr. George Davis at the University of Medicine and Dentistry of New Jersey) are pushing for the transabdominal cerclage to replace vaginal cerclages, due to perceived better outcomes and more pregnancies carried to term.