Women who have had prior pregnancy losses with painless premature opening of the cervix and delivery during their second trimester may be diagnosed with “cervical insufficiency” or “cervical incompetence.” Women who have had prior cervical surgery for dysplasia (such as a LEEP or cone-biopsy) and women with a history of other cervical “trauma” (such as multiple D&Cs or cervical laceration during a prior pregnancy) may be at increased risk for cervical incompetence. Therapy can include supplementation with progesterone and vaginal cerclage. Vaginal cerclage involves placing a suture or “stitch” around the upper cervix in a purse-string fashion to provide additional cervical support and to decrease the risk of preterm birth. A vaginal cerclage is generally a day surgery procedure. The cerclage can be removed in the office around 36-37 weeks of pregnancy, and vaginal delivery can occur after cerclage removal.
While most cervical cerclage procedures are performed at the end of the first trimester or early in the second trimester as a prophylactic cerclage in women with prior preterm delivery, some women may be referred for an “exam-indicated,” “emergent” or ”rescue” cervical cerclage. A patient may be considered for an exam-indicated cerclage if they are found to have a dilated cervix with protrusion of the bag of water into the cervix or if they have a history of prior preterm birth and are found to have a cervix that has shortened during the second trimester.