Cervical Cerclage - What is it?

From the moment you find out you are having twins, I can guarantee you will hear or read about your biggest risk, preterm labor. Preterm labor is characterized by contractions or irritability of the uterus between weeks 20-36 of gestation that cause effacement and/or dilatation of the cervix.  Here is the horrifying part - Preterm labor is the greatest cause of newborn illness and death in the United States.  How does this affect twin pregnancies?  Statistics show 70% of twins are born early. Eeeek!! 

When my doctor suggested that I have the surgical procedure called a cerclage, I wasn't sure what to think.  He explained that when a woman’s cervix is weak (sometimes called an incompetent cervix) she is more likely to have a baby born prematurely because the cervix shortens or opens too early. In order to prevent premature labor, a surgical procedure called cervical cerclage can be administered.  A cerclage is used to surgically close the cervix to prevent these early changes in a woman’s cervix, thus preventing premature labor. A closed cervix helps a developing baby stay inside the uterus until the mother reaches 37-38 weeks of pregnancy.

How does he know I have a weak cervix?  Well, considering my first baby was almost 24" long, that right there is an indicator that my cervix may be incompetent.  Secondly, just the fact that I am carrying twins, automatically puts me and my poor little cervix at risk.  My doctor (whom also delivered me 30 some odd years ago) told me, "If my daughters or wife were pregnant with twins, they would be getting a cerclage, no questions asked.  But it's NOT the standard of practice."  Hmmmm, so I could be spending thousands of dollars for something I'm not sure I need?

Then he said something that really stuck with me, "If you have the procedure, you will never know that you needed it.  But if you don't, and you have preterm labor, you could lose the babies, and then you would know that you needed it."  At that moment, I realized I did not want to take any risks, and I would be getting this procedure.  

There are several types of cervical cerclages currently used in practice.  The McDonald cerclage, uses a stitch procedure.  The Shirodkar cerclage, uses a band, somewhat similar to surgical tubing.  Using a stitch procedure has a higher risk of infection, and cannot be placed as high on the cervix as a Shirodkar.  My doctor strongly believes that the Shirodkar is a much more effective procedure and has a higher success rate of prevention.  So at 12 weeks gestation, I had the Shirodkar procedure.  

In the second post regarding the cervical cerclage, I will discuss how I managed through the procedure, recovery and associated costs.