Thursday, March 1, 2012

What is Cervical Cerclage ? - Wikipedia

Cervical cerclage (tracheloplasty), also known as a cervical stitch, is used for the treatment of cervical incompetence (or insufficiency), [1] a condition where the cervix has become slightly open and there is a risk of miscarriage because it may not remain closed throughout pregnancy. Usually this treatment would be done for a woman who had suffered one or more miscarriages in the past, in the second trimester of pregnancy.
The treatment consists of a strong suture being inserted into and around the cervix early in the pregnancy, usually between weeks 12 to 14, and then removed towards the end of the pregnancy when the greatest risk of miscarriage has passed.


There are three types of cerclage:[2]
  • McDonald cerclage, described in 1957 is the most common, and is essentially a pursestring stitch used to cinch the cervix shut; the cervix stitching involves a band of suture at the upper part of the cervix while the lower part has already started to efface. This cerclage is usually placed between 12 weeks and 14 weeks of pregnancy. The stitch is generally removed around the 37th week of gestation. [3]
  • Shirodkar cerclage is very similar, but the sutures pass through the walls of the cervix so they're not exposed. This type of cerclage is less common and technically more difficult than a McDonald, and is thought (though not proven) to reduce the risk of infection. The Shirodkar procedure sometimes involves a permanent stitch around the cervix which will not be removed and therefore a Caesarean section will be necessary to deliver the baby. The Shirodkar technique was first described by Dr. V. N. Shirodkar in Bombay in 1955. In 1963, Dr. Shirodkar traveled to NYC to perform the procedure at the New York Hospital of Special Surgery; the procedure was successful, and the baby lived to adulthood.[citation needed]
  • An abdominal cerclage, the least common type, is permanent and involves stitching at the very top of the cervix, inside the abdomen. This is usually only done if the cervix is too short to attempt a standard cerclage, or if a vaginal cerclage has failed or is not possible. However, a few doctors (namely Dr. Arthur Haney at the University of Chicago and Dr. George Davis at the University of Medicine and Dentistry of New Jersey) are pushing for the transabdominal cerclage to replace vaginal cerclages, due to perceived better outcomes and more pregnancies carried to term.[citation needed]


After the cerclage has been placed, the patient will be observed for at least several hours (sometimes overnight) to ensure that she does not go into premature labor. The patient will then be allowed to return home, but will be instructed to remain in bed or avoid physical activity for two to three days, or up to two weeks. Follow-up appointments will usually take place so that her doctor can monitor the cervix and stitch and watch for signs of premature labor.


While cerclage is generally a safe procedure, there are a number of potential complications that may arise during or after surgery. These include:
  • risks associated with regional or general anesthesia
  • premature labor
  • premature rupture of membranes
  • infection of the cervix
  • infection of the amniotic sac (chorioamnionitis)
  • cervical rupture (may occur if the stitch is not removed before onset of labor)
  • injury to the cervix or bladder
  • bleeding
  • Cervical Dystocia with failure to dilate requiring Cesarean Section
  • displacement of the cervix

[edit]Normal results

The success rate for cervical cerclage is approximately 80-90% for elective cerclages, and 40-60% for emergent cerclages. A cerclage is considered successful if labor and delivery is delayed to at least 37 weeks (full term).[citation needed][4]

[edit]Morbidity and mortality rates

Approximately 1-9% of women will experience premature labor after cerclage. The risk of chorioamnionitis is 1-7%, but increases to 30% if the cervix is dilated greater than 1.2 in (3 cm). The risks associated with premature delivery, however, are far greater. Babies born between 22 and 25 weeks of pregnancy are at significant risk of moderate to severe disabilities (46-56%) or death (approximately 10-30% survive at 22 weeks, increasing to 50% at 24 weeks, and 95% by 26 weeks).[citation needed]


Wednesday, February 29, 2012

My first trimester of second pregnancy ..

Syukur Alhamdulillah because Allah has granted one of my dreams in Finland to have my second pregnancy .. eventhough we do not plan it to be so early, but this is the most beautiful gift from Allah SWT ... Allah always planned the best for us …

I try to write something about my second pregnancy .. to be shared for the family, relatives and friends ... some knowledge and as inspiration to those have the same complication in pregnancy as I do ..  Because I believe every pregnancy has it own story itself .. there are similarities but with some differences .. I hope my story can be an inspiration for all going-to-be mother to have the patience and more motivated to face all the challenges of being a mother .. 

I do not regard my incompetency during my pregnancy as a disadvantage but as the attempt to be the test from Allah to always remember that Allah is the Almighty  .. I am a mother who has diagnosed with PCOS and incompetency or insufficient servicks ...but I am thankful to Allah for giving us the opportunity to have children after our long prayers …

I pray my second child would be in a very good health and as strong as papa.. Papa never stop giving us full support and doing so much sacrifices just the best for his children .. for me .. he is always the best husband and father and hope Allah will always be with him and give him the strength and patience …
Of course there is challenges being pregnant in a foreign country with a very different atmosphere here in Finland ... with severe morning sickness is different from my last pregnancy before ..  Luckily  there are friends here who share their experiences and guide me … I feel more comfortable and no worries as the midwives here are also helpful .. Alhamdulillah ..  the hospital system is very good and the services are awesome ..  I feel more confident and motivated with my pregnancy …

The time this article was written, my pregnancy is over 13 weeks old .. and in the second trimester of pregnancy ...Alhamdulillah during ultrasound scan session ...once again a sense of gratitude and joy is shared with eryssa and ezral .. the baby is very active and the Doctor said it is a good sign ... Eryssa keep shouting "Hey baby " while pointing at the screen in front of her ..

As for my illness and incompetency servicks so this time I alsowas confirmed by the Doctor to have a servical cerclage during my 14 weeks of pregnancy .. so next week I will be doing my surgical cerclage surgery on 16 February at 7.00 am .. mixed feelings ..but I should always be positive and strong .. I prayed to Allah to give me hope and strength and ... I leave everything to Allah ... amin ...

Oh ya, next time I ‘ll try my best to put more about PCOS, Incompetency Servicks and Cerclage Surgery… till then.. 

Wassalam ..

Lappeenranta, 10th February 2012