In what cases is the cervical stitch indicated?

This is an automatically translated article.

The article was professionally consulted by Specialist Doctor I Pham Thi Yen - Obstetrics and Gynecology Department - Vinmec Hai Phong International General Hospital

Cleft uterus is a condition in which the waist of the uterus thins and opens before the pregnancy is large enough for the baby to be born. This is one of the causes of sudden miscarriage in pregnant women. Cervical cerclage is an invasive procedure that reduces the risk of miscarriage and premature birth due to a cleft palate.

1. What is cervical stitch?

Cervical collar stitch is a procedure to sew a circle around the cervix to narrow the hole in the cervix, protect the safety of the fetus in the abdomen, prevent miscarriage and premature birth. Cervical cerclage is performed at 14-18 weeks of pregnancy, possibly from 13 to less than 20 weeks.
Pregnant women are prescribed cervical stitches after having an obstetric history examination, diagnostic imaging.
Obstetric or ultrasound history:
Massive miscarriage or preterm birth before 28 weeks ≥ 2 times in a row with features of rapid labor without pain. History of miscarriage or preterm delivery (between 14 and 36 weeks) characterized by rapid, painless labor with risk factors for cleft palate: dilation, cone-resection, neck amputation uterine prolapse, cervical laceration, collagen pathology, uterine or cervical abnormalities. Cervical length measurement via transvaginal ultrasound < 25mm and/or cervical change on examination at gestational age before 24 weeks with risk factors for cleft palate. Vaginal ultrasound image of the cervix:
Funnel-shaped inner cervical canal. Correlation between cervical length and cervical hole shape with T, Y, V, U types. Cervical length < 25 mm. Presence of pregnancy in the cervix or vagina.

2. In which case is the cervical stitch indicated?

Consecutive miscarriage due to uterine isthmus. In cases with a history of two or more miscarriages of unknown cause. In special cases such as twins where the ultrasound measures the cervical length less than 25mm

3. Contraindications

The following cases are contraindicated with cervical stitch:
Gestational age over 14 weeks. Vaginal and cervical infections. Thai dead.

4. Steps to sew the cervical collar

Expose the cervix. Antiseptic of the vulva, vagina and cervix. Performing the loop stitching Check the knot. Vaginal and cervical antiseptic.

5. Follow-up after cervical collar stitch surgery

The patient was put on bed rest after 3 days to monitor bleeding, uterine contractions, rupture of membranes. The medical staff will remove the gauze after 4-6 hours. Antibiotic (oral) and antispasmodic treatment. Normally, pregnant women will be discharged after 3 days and will be instructed to return to the hospital when there are: uterine contractions, vaginal bleeding, vaginal amniotic fluid, and the date of removal of only 37 weeks of pregnancy.

6. Complications can occur after cervical stitch

Bleeding: usually stops bleeding (except in cases of undetected blood disease) 3-4 hours after inserting hemostatic gauze. Infection: due to a non-sterile procedure, or a stable source of untreated genital tract infection. Causes miscarriage or premature birth: due to contractions. Amniotic fluid rupture, or leaking amniotic fluid. Break the needle into the cervix. At Vinmec International General Hospital, there is a package maternity service as a solution to help pregnant women feel secure because of the companionship of the medical team throughout the pregnancy. When choosing Maternity Package, pregnant women can:
The pregnancy process is monitored by a team of qualified doctors Regular check-up, early detection of abnormalities Maternity package helps to facilitate the process. birthing process Newborns get comprehensive care

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Reference source: Guide to the technical process of medical examination and treatment specialized in Obstetrics and Gynecology - Ministry of Health