Cervical cerclage

During pregnancy, the cervix must stay long and closed until term. In some women it opens too early, without painful contractions, which can lead to late miscarriage or very preterm birth. Cerclage consists of placing a strong stitch around the cervix to keep it closed. The procedure is done through the vagina, with no abdominal incision, usually under spinal anaesthesia. It is either planned at the end of the first trimester in women with a relevant history, or decided during pregnancy when the ultrasound shows a shortening cervix. Less often, it is done as an emergency when the cervix is already open. The decision is made by the obstetrician after careful review of the history and the cervical ultrasound. Cerclage is not suitable in every situation, for example if there is infection, active bleeding or ruptured membranes. At Clinique Pasteur Tunis, cerclage is performed in the operating theatre by the obstetric team, with monitoring of the baby before and after the procedure. The stitch is removed at the end of pregnancy, around 36 to 37 weeks, or earlier if labour begins.