Dr. Andrei Rebarber joins the podcast once again to talk about cerclage, a surgical procedure for women experiencing cervical incompetence. In this episode, Dr. Rebarber explains why the procedure is “controversial,” when a patient needs a cerclage, and more.
“Cerclage: At Your Cervix!” – with Dr. Andrei Rebarber
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In this episode, Dr. Rebarber and Dr. Fox discuss cerclage, an “operation to support and maintain the pregnancy by putting a suture around the cervix” as Dr. Rebarber explains. Cerclage has been in use since the 50s, but Dr. Fox says it’s a controversial procedure regarding which patients truly require the surgery and when.
Why is Cerclage Controversial?
Dr. Fox explains the cervix as “like the knot in a balloon.” In some cases, the cervix will become too short or begin to dilate too early in the pregnancy. The cerclage procedure is designed to be a solution for this condition, known as cervical incompetence. However, Dr. Rebarber explains that “we have a surgery, but we’re still trying to find out the diagnosis.” This is because cerclage was developed before clinical trials were the norm, so, Dr. Fox says, “we’re kind of trying to catch up.” Doctors are usually unsure how or why a weakened cervix occurs, and there is currently not a diagnostic option to predict whether the cervix will be sufficient throughout a pregnancy. In some cases, what seems like an incompetent cervix could be a symptom of another problem, making it difficult for doctors to determine whether the cerclage is necessary.
However, Dr. Rebarber says that “the majority of people benefit from this, and the risks are few.” When determining whether a patient needs a cerclage, Drs. Fox and Rebarber describe three “camps” of patients:
- History indicated, meaning the patient’s prior pregnancies indicate something wrong with the cervix
- Ultrasound indicated, meaning that their ultrasound shows that the cervix looks short, despite no dilation taking place yet
- Exam indicated, meaning that the patient’s cervix is dilating before 20 weeks
The Cerclage Procedure
Most cerclage is performed vaginally. For the patient, the experience is overall similar to a pap smear. They receive anesthesia, typically through an epidural, but remain awake for the procedure, which usually takes a half hour or less. Some cerclages, however, must be performed abdominally. The patient can usually go home after the procedure, but they may have to stay in the hospital so their doctor can observe them overnight if they have other complications. Dr. Fox explains that “the cervix itself does not have pain fibers,” so aside from cramping patients shouldn’t feel pain. Activity, aside from sex, isn’t restricted after the procedure. Drs. Fox and Rebarber will schedule an ultrasound at about two weeks after the cerclage, then “if nothing happens with preterm labor, typically we take the cerclage out at 36-37 weeks.”