A cervical cerclage, or a cervical stitch, is a stitch that is placed on the cervix to tighten it and thus prevent a miscarriage from occurring. The cervix is the lower part, or the neck of the uterus, and it should be firmly closed during pregnancy. The common way of doing a cervical cerclage is to place the stitch through the vagina on the lower or middle portion of the cervix.
An abdominal cerclage involves placing the stitch through the abdomen on the uppermost part of the cervix – this makes it more secure. Once an abdominal cerclage is placed it does not need to be removed and can be used for subsequent pregnancies. However, having an abdominal cerclage means that delivery can only be through a Caesarean section.
An abdominal cerclage is usually recommended or offered for either of the following reasons:
- Previous failed routine (transvaginal) cervical cerclage – i.e. pregnancy loss(es) in spite of having a cervical cerclage(s) done
- Previous cervical surgery or lacerations that will make a transvaginal cerclage difficult or impossible to do
- Naturally short or poorly developed cervix
Unlike a transvaginal cervical cerclage which is only performed when one is already pregnant, an abdominal cerclage can be placed before pregnancy has occurred. This is called a Prophylactic Abdominal Cerclage.
An abdominal cerclage can be done in either of two ways – an Open Abdominal Cerclage where a cut is made on the lower abdomen to gain access to the uterus, or a Laparoscopic Abdominal Cerclage which is done through small cuts on the abdomen measuring about 5 to 10mm, with the use of laparoscopic instruments.