Sutures on the cervix during pregnancy

The body changes significantly during pregnancy in order to support the developing baby. One of the difficulties some women may encounter is the possibility of an early birth brought on by a weak cervix. In these situations, medical professionals might advise a cervical cerclage procedure, which entails sewing the cervix in order to help delay labor.

When a woman is diagnosed with cervical insufficiency, a condition where the cervix opens too soon, the decision to suture the cervix is typically made. Since there may not be any discomfort or contractions associated with this, routine examinations are crucial to track any changes.

Cervical cerclage can be a useful tool in reducing the risk of preterm birth, but concerns regarding the procedure and its effects on pregnancy are understandable. In order to reduce anxiety and guarantee a more seamless experience for mother and baby, it can be helpful to understand why it’s done, how it’s done, and what to expect.

What is it?

If the cervix is unable to fulfill its direct responsibilities for any reason, suturing the cervix becomes necessary and offers a genuine opportunity to preserve and prolong the pregnancy. Following fertilization, the cervix closes tightly. The cervical canal constricts and becomes mucus-filled. The major and crucial job of this component of the female reproductive organ is to keep the developing fetus inside the uterine cavity and prevent it from emerging too soon.

In addition to holding, the cervix with a mucous plug prevents pathogenic bacteria, viruses, and other unpleasant uninvited "guests" from entering the uterine cavity from the vagina, which can cause intrauterine infection of the baby. This is dangerous, because infections suffered in the embryonic and later periods usually end in malformations and severe pathologies congenital nature, intrauterine death of the baby. If the cervix does not provide adequate protection for the growing baby, then the likelihood of miscarriage and premature birth increases. If the baby by this time is not yet able to survive on its own in this world, then such a birth will end tragically. In order to strengthen the weak cervix, doctors recommend suturing it in certain situations so that a mechanical barrier in the form of stitches does not allow it to open prematurely.

Indications

• high risk of miscarriage or premature birth due to the presence of similar cases in the anamnesis;
• habitual miscarriage in the 1st and 2nd trimesters of pregnancy;
• miscarriage in the third trimester;
• early shortening and opening of the cervix, dilation of the internal or external os;
• questionable scars left as a "memory" from previous births in which cervical ruptures occurred;
• any destructive changes in the cervix during pregnancy that are prone to further development.

On the basis of one examination in a gynecological chair, the doctor cannot determine that suturing is necessary. He requires detailed information regarding the state of the cervix, the lower segment of the uterus. A full biometric examination is recommended in order to address this, which entails a PCR smear for chlamydia, an ultrasound diagnostic, a general blood test, and a laboratory analysis of a smear and bacterial culture from the cervical canal.

A decision to suture the cervix should only be made after determining all risk factors, measuring the cervix’s length and width, evaluating the state of the cervical canal inside it, and reviewing the patient’s medical history.

Contraindications

It is only feasible to suture this organ during pregnancy if there are no other global issues found in the pregnancy in addition to a weak cervix. The operation will have to be stopped if any concurrent pathologies are found. Among the contraindications are:

• heart and vascular diseases, kidney diseases that have worsened in the expectant mother due to pregnancy, the risk of death of the woman in the case of mechanical prolongation of pregnancy;
• bloody discharge that increases in strength and nature, as well as recurrent bleeding when threatened;
• gross malformations of the baby;
• hypertonicity of the uterus, which cannot be reduced with the help of medical conservative treatment;
• chronic inflammation of the reproductive organs of a woman, the presence of a bacterial or fungal infection, STIs;
• late detection of cervical pathologies – after 24 weeks of pregnancy (the best time for a successful intervention is considered to be the period from 14 to 21 weeks).

How the operation is performed?

The time that the procedure is carried out is very crucial. The child is not large enough to significantly stretch the cervix’s muscles or the uterine walls between 14 and 21 weeks; at later stages, suturing is not advised because the strongly stretched tissues may not be able to tolerate the sutures and they may rupture.

The procedure, known as "cervical cerclage" in medical parlance, is limited to hospital settings. Since the woman is receiving intravenous or epidural anesthesia, it is not regarded as unbearably painful.

You don’t have to be afraid of it because skilled anesthesiologists will determine the medication dosage by considering the expectant mother’s body type, weight, and health as well as the baby’s developmental characteristics and her own gestational age. Both the mother and the fetus will be safe from the dose.

The entire manipulation process takes no more than thirty minutes. The procedure is very straightforward: strong surgical threads are used to suture the outer edges of the cervix together.

This approach necessitates thorough planning. The repercussions of an infection in the uterus will be absolutely catastrophic. Within the female reproductive organ, the suturing will create a closed space where any microbe can start growing quickly. Initial care involves giving the woman antibiotics and thoroughly cleaning her vagina. Still, it’s not always helpful.

The actual application of the sutures varies, with each surgeon having a preferred method that is largely dependent on the anatomical characteristics of a particular patient.

Laparoscopic surgery can be used to perform the cerclage itself. It has many benefits, including quickness, a relatively easy recovery after surgery, minimal blood loss, and a decreased risk of complications.

Women who have a cervix that is naturally shortened or who have had a vaginal suture application procedure that was unsuccessful should consider laparoscopic cerclage.

Possible problems and complications

Similar to any surgical procedure, cerclage may also result in complications. The most hazardous ones are when an infection develops, when an inflammatory process starts, and when the tone of the uterine muscles increases. When an internal infection cannot be "defeated" during the preoperative period, inflammation may result. A woman may occasionally experience a unique allergic reaction to the suture material that medical professionals use.

Burning sensations, mild pain syndrome, and prolonged discharge following surgery could all be signs of potential issues. Furthermore, inflammation may develop a few weeks after the stitches are placed in addition to right after surgery. Because of this, it’s critical to see your doctor more frequently and keep an eye out for any changes.

The uterus’s response to surgery and foreign suture material for its structures can also result in hypertonicity. After surgery, it’s common to experience some abdominal heaviness and mild pulling sensations; however, these should go away eventually. You should let your doctor know if this doesn’t occur.

Although it doesn’t happen frequently, a woman’s body can violently reject surgical threads as a foreign object, triggering an intense immune rejection process that may cause pain, an unusual discharge, and a high fever.

Later on, if labor has started and the stitches have not yet been taken out, cerclage may have another unpleasant side effect: the stitched cervix may sustain significant damage. Consequently, it’s crucial to visit the hospital ahead of time at 36–37 weeks rather than asking the doctor to "stay at home for another week."

Recommendations for the postoperative period

The woman will require several more days of hospitalized round-the-clock medical observation following the intervention. Antispasmodic medications are prescribed to her in order to lessen the uterine muscle tone, along with strict bed rest. Every day, vaginal sanitization is done to prevent infection. The expectant mother can then be sent home. Following the intervention, discharge lasts for roughly three to five days.

The expectant mother will need to reevaluate her lifestyle up until the time of delivery due to stitches on the cervix. Prolonged standing, walking, or physical activity are not recommended. You should never lift weights. Additionally, you should refrain from having sex in order to prevent the uterus from becoming hypertonic, which could require cutting the stitches.

The woman will need to keep an eye on her stool until the birth; constipation is not something you want because pushing is not permitted. As a result, you will need to start a diet, increase the amount of fresh fruits and vegetables in your diet, drink more juice, cut back on salt, and eat a lot of foods high in protein as well as pastries and buns.

You’ll need to see the doctor more frequently than most women in this role. The physician will keep an eye on the stitches’ condition, collect smears to test for vaginal microflora, and, if required, recommend unscheduled ultrasound examinations to measure the cervix’s dimensions and evaluate its internal structures.

At 36–37 weeks, a woman who has stitches on her uterus must visit the maternity hospital. The stitches are taken out at this point. After this, labor can begin at any time, even on the same day.

There is no need for anesthesia or other forms of anesthesia, and removing the stitches itself is not painful.

Cervical cerclage, or sutures on the cervix during pregnancy, is a technique used to delay childbirth in women whose cervix may open too soon. By keeping the cervix closed, this procedure helps support the pregnancy and lowers the risk of preterm labor. When needed, doctors will often recommend this common and safe intervention to help ensure a longer and healthier pregnancy.

Prognosis and consequences

Over 80% of cases of pregnancy following cerclage are quite high. The degree of cervical insufficiency and the reasons the woman was recommended for surgical intervention determine the prognosis. The likelihood of carrying the child to 36–37 weeks increases significantly if she complies with all of the doctor’s instructions following the procedure.

Though it can seem overwhelming, getting stitches on the cervix during pregnancy is a common procedure that helps ensure a healthy pregnancy. You can lower the risks and concentrate on your well-being by taking care of yourself and adhering to your doctor’s advice.

You can stay on track throughout your pregnancy with rest and routine exams. Always get in touch with your healthcare provider if you have any questions or notice anything out of the ordinary.

Keep in mind that each pregnancy is unique, so what suits one woman may not suit another. Have faith in your physician and your body to help you through this process.

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