Faced with the threat of premature birth, cerclage emerges like a medical superhero, arming future mothers with an invincible shield to protect their most precious treasure. This surgical procedure, both daring and miraculous, promises to keep the specter of prematurity at bay, offering a glimmer of hope where uncertainty reigned. Discover how cerclage can transform your pregnancy journey away from the torments of uncertainty.
What is Pregnancy Cerclage?
Pregnancy cerclage is a surgical procedure intended to prevent premature birth and miscarriage in cases of cervical insufficiency. This condition occurs when the weakened cervix opens too early during pregnancy, no longer able to support the growing weight of the baby. By placing a strong suture around the cervix, the cerclage acts as a guardian, preserving the pregnancy until a safer term.The Different Types of Strapping
Strapping comes in two main forms, each adapted to specific situations:- Transvaginal Cervical Cerclage : Carried out vaginally, this type is the most common. It involves placing a suture around the cervix, accessible through the vagina.
- Transabdominal Cervical Cerclage : Performed abdominally, this type is considered when transvaginal cerclage is not possible or has failed. It requires a more invasive surgical approach.
| Strapping Type | Access road | Indications |
|---|---|---|
| Transvaginal | Through the vagina | General cases of cervical insufficiency |
| Transabdominal | Through the abdomen | Cases where transvaginal cerclage is not possible or has failed |
The Perfect Timing for Strapping
Choosing the optimal time to perform a cerclage is crucial to maximize its effectiveness while minimizing risks to the mother and fetus. Typically, this procedure is performed between the 12th and 14th week of pregnancy, a time window that is not chosen at random. During the first trimester, the fetus is still in the initial developmental stage, and the cervix is not under significant pressure.
It is from the 12th week that the baby begins to grow more quickly, gradually increasing the pressure on the cervix. Performing the cerclage at this early stage therefore allows the cervix to be supported before this pressure becomes too great, which would help prevent premature dilation or effacement of the cervix which could lead to premature delivery.
Additionally, performing a cerclage after the 14th week may be riskier due to the increased pressure from the uterus and the higher risk of causing contractions or premature rupture of the membranes, especially if the cervix has already started to change.
By carefully choosing the timing for cerclage, we aim to intervene early enough for the procedure to be as beneficial as possible, while avoiding complications associated with later intervention. However, in some cases, a cerclage may be placed later in the pregnancy if a risk of premature delivery is identified during regular monitoring.
These decisions are made based on a careful assessment of the health of the mother and fetus, taking into account the specific benefits and risks of each situation.
Strapping Risks and Considerations
- Infection : One of the most common complications is the risk of infection, which can occur in the cervix or surrounding tissues. Symptoms of an infection may include fever, lower abdominal pain, and unusual discharge.
- Bleeding : Some patients may experience bleeding after the procedure, resulting from manipulation of the cervix. Although often minor, this bleeding requires monitoring to ensure it is not a sign of a more serious complication.
- Premature rupture of membranes (PROM) : Cerclage can increase the risk of premature rupture of membranes, which can lead to premature delivery. This risk is particularly monitored in women having transabdominal cerclage, due to the more invasive nature of the procedure.
- Reaction to strapping : In rare cases, the body may react poorly to cerclage, resulting in contractions, irritation, or pressure on the cervix, all of which can threaten the continuation of the pregnancy.
In what cases is Strapping Recommended, or even Essential?
Cerclage is an intervention considered in very specific situations, where the risk of premature delivery is increased due to cervical weakness or insufficiency. This cervical weakness can be difficult to detect before a problem occurs, but there are certain scenarios where cerclage becomes not only recommended but sometimes essential for the health of both mother and baby.- History of premature births : Women with a history of premature births, especially those occurring without a known cause or due to cervical insufficiency, are often considered candidates for cerclage. Past experience of such events indicates an increased risk that the situation will be repeated in subsequent pregnancies.
- Second trimester pregnancy losses : Women who have experienced one or more second trimester pregnancy losses without an explicit cause other than the possibility of cervical insufficiency may benefit from cerclage. These unfortunate events may be the result of a cervix opening prematurely under the weight of the growing baby.
- Diagnosis of cervical insufficiency : In some women, a diagnosis of cervical insufficiency can be made before or during pregnancy through medical tests, including transvaginal ultrasound which may show shortening of the cervix earlier than expected. In such cases, cerclage may be considered to prevent premature opening of the cervix.
- Cervical changes observed during pregnancy : For pregnant women, regular monitoring may reveal warning signs of cervical insufficiency, such as shortening or premature effacement of the cervix, detected by ultrasound. If these changes occur early in pregnancy, cerclage may be recommended as a preventative measure.
Impact on Sexual Relations
After cerclage, a break from sexual intercourse is often recommended to minimize the risk of complications. This precaution aims to reduce the risk of complications such as infection or stimulation of the cervix, which could lead to its premature opening.
For example, in the case of a transvaginal cervical cerclage, where the suture is more accessible and potentially more sensitive to pressure or infection, doctors often advise avoiding sexual intercourse until removal of the suture, which is usually planned. a few weeks before the due date.
It is also recommended to avoid sexual intercourse in the following situations:
- If bleeding was observed after cerclage placement, potential sign of irritation or small lesion of the cervix.
- When signs of infection are present, such as unusual discharge, itching or burning, which could be exacerbated by sexual activity.
- If abdominal pain or contractions are felt after cerclage, indicating that the cervix may be stressed.
Conclusion
Pregnancy cerclage represents a key strategy in preventing premature birth for some women. By strengthening the cervix, this procedure can offer a significant chance of achieving a safer term of pregnancy, contributing to the health and well-being of the mother and her baby. Like any surgical procedure, pregnancy cerclage requires a thorough discussion between the patient and her medical team to ensure she is well informed of the benefits, risks, and post-operative care required.
