When my sister-in-law was pregnant she was cast into bed rest at just over 20 weeks. A routine exam had revealed she had a short cervix threatening to dilate way too early. She was told to immediately stop working and stay in bed, getting up only to use the bathroom and bathe. I was shocked this was the only advice given to her by her doctor. Wasn’t there more that could be done? I had heard of a stitch that could be put in a woman’s cervix to help prevent it from dilating prematurely, but my sister-in-law told me her doctor had not recommended this, telling her that it was relatively ineffective. Was this true, or did that doctor simply have something against performing these procedures, preferring to take a more conservative approach?

Cervical cerclage, a procedure in which a band of very thick thread is used to stitch the cervix closed much like a drawstring purse, may be recommended in cases of cervical incompetence. Cervical incompetence is described as the cervix’s inability to remain closed under the pressure of a growing uterus. This is not the same as a shortened cervix or other forms of complications that can lead to premature labor. For these situations, a cervical cerclage is not an appropriate treatment method.

Though some doctors still recommend a cervical cerclage be put into place in those women who have been identified as having short cervices, studies have indicated this may have little to no impact on the chances of the woman experiencing premature labor, or the mortality of the baby born prematurely. In studies comparing women receiving a cerclage with women who did not, the difference in the instance of premature delivery and infant mortality was statistically insignificant. Though the group receiving the cerclage did experience lower overall numbers of premature delivery and infant mortality, the difference was so small it cannot be conclusively stated the cerclage should be recommended as a reliable course of treatment. When considering the complexity of the procedure, the need for anesthesia and pain management measures, and the potential for serious infection, failure and injury, many doctors do not consider this treatment a viable option for most women, particularly when she is beyond 14 weeks of pregnancy. Instead, women with incompetent or otherwise compromised cervices are recommended bed rest for the rest of their pregnancies to help prevent premature labor.

Source: VC Heath, et al. Cervical cerclage for prevention of preterm delivery in women with short cervix: randomized controlled trial, Lancet [2004, 363(9424):1849-1853]

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