All about Cervical stitches.
This post is about the different cervical stitches, why they are used. How they are put in. Alongside other treatments of incontinent cervix (IC). I will also go over what one Ben is having. There are a few different types of stitches that all are placed in the cervix depending on what state of IC somebody has, previous history of pregnancy loss and generally just different specialist judgements.
There are two main types of cervical stitches:
1) Trans abdominal cerclage (TAC), also known as the abdominal stitch. It is inserted through the abdomen using keyhole surgery or open laparotomy, a similar way to a caesarean section. This is usually done under general anaesthetic.
This stitch is normally only placed when a person has little to no cervix or have previously had failed vaginal stitches, which unfortunately did not work therefore lead to a loss or premature births of their babies. The TAC stitch is still relatively new and only performed by a few specialist. It is mostly placed before getting pregnant or early on in pregnancy. Also the baby then has to be delivered thought caesarean around 38 weeks.
It is dangerous to carry to full term in case you go into labour, Because it prevents waters from breaking. This has high risks of ripping the TAC or developing an infections. The TAC can be removed when a caesarean is done at the birth or it can be left in for further pregnancies. The TAC does not stop sperm getting up or menstruation flow.
2) Transvaginal cerclage (TVC) also known as the vaginal stitch, is inserted via the vagina during day surgery. This is a non- invasive surgery with a spinal anaesthetic. This stitch can be put in at the beginning of the second trimester (12-16 weeks). This is normally the case if IC has already been diagnosed or a person has had the stitch placed in previous pregnancies. If not it can be put in as emergency up to 28 weeks as a result of cervix shortening or if it starts to open, shown in cervical measurement scans.
There are two different variations of the vaginal stitch. The low vaginal stitch, sometimes called the McDonald Cerclage or the high vaginal stitch, called a Shirodkar Cerclage or Transvaginal Cervicoisthmic Cerclage (TRICIA for short.)
After the surgery some mild cramping and bleeding can be present for a few days, however most cases people who have this type can go home the same or next day. The stitch is then removed between 34 to 37 weeks of pregnancy so birth can happen naturally. Sometimes labour occurs quickly after the stitch is removed but in most cases the pregnancy goes on to full term. However if labour happens before the 37 weeks, the stitch will be removed immediately to prevent cervical tearing or infections.
Ben is having this type. He is having the McDonald Cerclage meanwhile our specialist said she will place the stitch higher up so basically where the TRICIA goes, as the further up the stitch is placed the lower the risks for preterm birth, resulting in the surgery being more effective. Ben will have this on Wednesday via regional anaesthetic in his spine. He will be awake during the surgery but will not feel anything. He will then have to stay in for at least 24 hours, due to having a urinary catheter in and being put on antibiotics to prevent any infections. Along with him and the baby being monitored. After they will put a plan in place for monitoring and what care Ben is to take for the duration of the pregnancy.
It is dangerous to carry to full term in case you go into labour, Because it prevents waters from breaking. This has high risks of ripping the TAC or developing an infections. The TAC can be removed when a caesarean is done at the birth or it can be left in for further pregnancies. The TAC does not stop sperm getting up or menstruation flow.
There are two different variations of the vaginal stitch. The low vaginal stitch, sometimes called the McDonald Cerclage or the high vaginal stitch, called a Shirodkar Cerclage or Transvaginal Cervicoisthmic Cerclage (TRICIA for short.)
Depending on different surgeons it varies on which type is placed and how far up the stitch goes. While taking in the medical history of the patients and the structure of the cervix.
After the surgery some mild cramping and bleeding can be present for a few days, however most cases people who have this type can go home the same or next day. The stitch is then removed between 34 to 37 weeks of pregnancy so birth can happen naturally. Sometimes labour occurs quickly after the stitch is removed but in most cases the pregnancy goes on to full term. However if labour happens before the 37 weeks, the stitch will be removed immediately to prevent cervical tearing or infections.
Ben is having this type. He is having the McDonald Cerclage meanwhile our specialist said she will place the stitch higher up so basically where the TRICIA goes, as the further up the stitch is placed the lower the risks for preterm birth, resulting in the surgery being more effective. Ben will have this on Wednesday via regional anaesthetic in his spine. He will be awake during the surgery but will not feel anything. He will then have to stay in for at least 24 hours, due to having a urinary catheter in and being put on antibiotics to prevent any infections. Along with him and the baby being monitored. After they will put a plan in place for monitoring and what care Ben is to take for the duration of the pregnancy.
If any person has any of the listed below then the stitch will not be placed.
- contractions pains
- evidence of infection
- vaginal bleeding
- waters have broken- preterm premature rupture of membranes (PPROM)
- baby shows signs of being unwell.
risks:
- infection
- bleeding
- injury to the cervix or bladder
A rare risk with cervical stitch is it can cause Preterm premature rupture of membrances (PPROM) and result in a miscarriage however this is mainly when the stitch is an emergency, putting it in later in the pregnancy when the cervix is already opening. Alternatively it can just be the result of IC it's self rather then the fact the stitch was put in. These stitch do not work for everyone. If their is any signs of labour the stitch has to be removed straight away.
additionally doctors may request bed rest, antibiotics and progesterone as alternative treatment or alongside these cervical stitches.
Ben has been signed off work told to rest on the ground of this he is on bed rest with midwives and others advise, until his surgery next week. He has also been given cyclogest pessaries to take. Cyclogest is a progesterone hormone based pessary used in pregnancy for many reason but mainly to prevent preterm labour. It can be inserted either into the vagina or rectum (bottom). In both cases the progesterone from the pessaries is aborted into the bloodstream. Helpful tips we got was to use panty liners because it is oily this does increase the amount of discharge. It can cause a bit of spotting or if put into the rectum it also can cause lose stools. While it is somebodies own preference, always follow the doctors orders.
There is not much research done on the effectiveness of these treatments so the results are still inconclusive, however when researching, as well as talking to others on support groups it is clear that their is not just the benefits to the stitch but also when taking cyclogest and being on bed rest. Sometimes the cervix is weak or shortens because of the increasing pressure in pregnancy meaning some peoples cervix can not hold the growing weigh from the baby. Bed rest takes pressure off the cervix by laying down, as when standing the gravity causes the increase weight of the baby to push down on the cervix. Doctors are unable to fully say whether bed rest works to prevent the cervix from shortening or going into preterm labour but we will do anything that will help this pregnancy and give our rainbow baby every chance.
We have found support online from others who are in similar situations or from others who we personally know that have had either the stitch or TAC put in. This really is important for mental support, alongside friends, family and the physical care from health providers. It is just so vital to have others who are going through or have already gone through the same thing. Go online, on Facebook, Youtube and blogs like this to find out others experiences. We are always happy to answer any questions or give advice, so please comment, tell us your stories and we can all support each other.
Read more on Tommy's website (link below) for further information on these stitches and the benefits and risks that comes with these procedures.
(Written at 15 weeks.)
References:
additionally doctors may request bed rest, antibiotics and progesterone as alternative treatment or alongside these cervical stitches.
Ben has been signed off work told to rest on the ground of this he is on bed rest with midwives and others advise, until his surgery next week. He has also been given cyclogest pessaries to take. Cyclogest is a progesterone hormone based pessary used in pregnancy for many reason but mainly to prevent preterm labour. It can be inserted either into the vagina or rectum (bottom). In both cases the progesterone from the pessaries is aborted into the bloodstream. Helpful tips we got was to use panty liners because it is oily this does increase the amount of discharge. It can cause a bit of spotting or if put into the rectum it also can cause lose stools. While it is somebodies own preference, always follow the doctors orders.
There is not much research done on the effectiveness of these treatments so the results are still inconclusive, however when researching, as well as talking to others on support groups it is clear that their is not just the benefits to the stitch but also when taking cyclogest and being on bed rest. Sometimes the cervix is weak or shortens because of the increasing pressure in pregnancy meaning some peoples cervix can not hold the growing weigh from the baby. Bed rest takes pressure off the cervix by laying down, as when standing the gravity causes the increase weight of the baby to push down on the cervix. Doctors are unable to fully say whether bed rest works to prevent the cervix from shortening or going into preterm labour but we will do anything that will help this pregnancy and give our rainbow baby every chance.
We have found support online from others who are in similar situations or from others who we personally know that have had either the stitch or TAC put in. This really is important for mental support, alongside friends, family and the physical care from health providers. It is just so vital to have others who are going through or have already gone through the same thing. Go online, on Facebook, Youtube and blogs like this to find out others experiences. We are always happy to answer any questions or give advice, so please comment, tell us your stories and we can all support each other.
Read more on Tommy's website (link below) for further information on these stitches and the benefits and risks that comes with these procedures.
(Written at 15 weeks.)
References:
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