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General Practice 2023

Uterine cerclage: what é, like é made and recoverção

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Uterine cerclage: what é, like é made and recoverção
Uterine cerclage: what é, like é made and recoverção

Uterine cerclage, or cerclage of the uterine cervix, is a surgery performed by the obstetrician during pregnancy to prevent the baby from being born before the expected time. Generally, this surgery is indicated for women who have cervical insufficiency, which is a dilation that can start in the first or second trimester of pregnancy, and increase the risk of premature birth or miscarriage.

Uterine cerclage surgery is performed by the obstetrician in the hospital, transvaginally and, in some cases, by laparoscopy, and can be performed urgently or on a scheduled basis by the obstetrician.

The recovery of the uterine cerclage is fast but requires some care, such as avoiding exertion in the first days or intimate contact in the first weeks, as instructed by the obstetrician.

When is indicated

Uterine cerclage surgery may be indicated by the obstetrician to prevent the risk of premature birth or miscarriage in women who have cervical insufficiency or short cervix.

The main indications for uterine cerclage are:

  • History of second trimester pregnancy loss related to cervical dilatation or placental abruption;
  • History of spontaneous loss or premature birth at less than 34 weeks' gestation, due to a short cervix;
  • Dilation of the cervix during the second trimester of pregnancy;
  • History of uterine cerclage due to painless cervical dilatation in the second trimester;
  • Short cervix, less than 25 millimeters, before 24 weeks of pregnancy.

Usually, uterine cerclage is indicated to be performed between 12 and 14 weeks of gestation, but it can also be done up to 23 weeks, in case the gynecological exam or ultrasound shows insufficiency of the uterine cervix. Understand better what cervical insufficiency is.

In addition, emergency uterine cerclage may be indicated by the obstetrician in case of advanced cervical dilatation, in pregnancy less than 24 weeks, and with no contractions, intra-amniotic infection or placental abruption.

Cerclage can only be performed during pregnancy and is not indicated for women who have not yet become pregnant, even if they have had previous abortions.

How to prepare for surgery

Uterine cerclage surgery can be done as an emergency, but it can also be scheduled by the obstetrician. In this case, some precautions are important to prepare for the surgery, such as clarifying with the doctor all doubts about the surgery, recovery and risks for the woman and the baby.

Before performing the surgery, the doctor must perform an ultrasound to check the baby's vital signs, such as heartbeat, in addition to assessing whether the fetus has any malformations.

Another test that the doctor may perform other tests such as an evaluation of cervical secretions and an amniocentesis, to identify infections.

How the surgery is performed

Uterine cerclage surgery is simple, takes about 20 minutes, and consists of sewing the cervix with a few stitches.

This surgery is performed in the hospital, with hospitalization, and before starting the surgery, saline solution is administered into the vein, by the nurse, to hydrate and administer medication, if necessary.

Uterine cerclage is performed under epidural anesthesia and is usually performed transvaginally, however, in some cases, the doctor may decide to perform it laparoscopically.

The procedure is considered safe for both the woman and the baby, but there are still some risks, such as the development of uterine infection, rupture of the amniotic membranes, vaginal bleeding or laceration of the cervix, for example.

What is recovery like

Recovery after uterine cerclage surgery, in the first 1 to 2 days, is carried out in the hospital, accompanied by the obstetrician, the anesthesiologist and the nurse. During this period, the doctor may prescribe painkillers and medicines such as Utrogestan, to prevent uterine contractions.

Also, right after the surgery, the doctor may do an ultrasound to check how the stitches are and to see if the baby is okay.

The woman should rest and avoid intimate contact in the first few weeks. In addition, it is also not recommended to exercise, lift weights or make great efforts, at least in the first 3 days after surgery.

How is childbirth after cerclage

Usually, the cerclage is removed around 37 weeks of pregnancy, however if the delivery is by cesarean section, it is not necessary to remove the cerclage, as it may be useful in the next pregnancy.

The decision on the type of delivery should be discussed between the woman and the doctor, observing the indications, advantages and disadvantages of each one. Check out the differences between normal and cesarean delivery and when they are indicated.

Possible complications

The main complications of uterine cerclage surgery are infection, inflammation of the fetal membranes, vaginal bleeding, laceration of the cervix or premature rupture of the membranes.

Furthermore, although rare, complications of epidural anesthesia such as a drop in blood pressure, chills, tremors, nausea, vomiting, fever, infection, nerve damage near the site or epidural bleeding, for example, may occur.

Warning signs to return to the doctor

It is important to consult the obstetrician or seek the nearest emergency room if symptoms such as:

  • Fever;
  • Intense abdominal pain;
  • Cramping;
  • Vaginal bleeding;
  • Smelly discharge.

These symptoms may indicate an infection and, in such cases, medical help should be sought immediately, as the infection can be life-threatening for both mother and baby.

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