Expert: Lawrence Jay Rappaport <B>M.D.</B> - 10/11/2005
Question Hi there,
I am really confused. Today I went to the gynae and she told me I have a small cervix and my cervix now measures 2.7 cm (after my abortion). I was a little worried as to what she means. She told me the cerclage ( stitch around my cervix) that i had done before couldn't help me because I suffered from contractions earlier on and she requested that I do another option that is the Shirodkar suture which means I have to do an operation first and then get pregnant. When it is time to deliver I have to do a caesaran. But she also told me that this is also not a 100% chances as well. If I have contractions I have to do a caesaran even if the baby is still pre-term..The thing I don't understand is my stitch didn't open, I was admitted because I had some contractions and bleeding and they had to cut off the stitch because my baby had died due to his umbilical cord..so does that mean the stitch didn't work for me? Is there no way to prevent the contractions? Do i really need to do the Shirodkar suture? I really don;t know what to do and I really wish to have a baby of my own and not lose another one...
Karen
Answer Nowadays, we only use the McDonald cervical cerclage (the type that you had placed). In the past (20 years ago) we used the Shirodkar procedure, which entails imbedding the stitch into the cervical wall. The Shirodkar stitch is permanently left in and you would have cesarean sections from then on. The McDonald procedure is better and safer and you can have the stitch removed prior to going into labor and have a vaginal delivery. If your cervix is shorter than 3cm, there is a higher risk of preterm labor. For that reason, we would put you on bedrest and curtail your activities. You may be started on tocolytic agents (terbutaline). If you have a cerclage stitch and then either the baby dies or your break your water, the stitch must be immediatly removed to prevent infection. If you have an incompetent cervix, the cerclage is preferable. A cerclage will not guarantee that you do not go into preterm labor, especially with a shortened cervix, but it may help prolong the pregnancy
