Cerclage of the uterus and premature birth

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Catherine Le Nevez
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Cerclage of the uterus and premature birth

Is it possible to avoid premature birth? When there are already precedents in the woman or worrying episodes occur during pregnancy, it is possible to intervene with uterine cerclage (Read), a sort of band that is inserted into the cervix to prevent the uterus from shortening and dilating in such a way as to trigger a preterm birth.

Giving birth too early is the fear of many future mothers, it is the fear of giving birth to a child that is too small and not yet ready to live independently and in a self-sufficient way due to the immaturity of its small organs.

READ MORE: Malformations of the uterus

There are many reasons that can trigger a preterm birth or exactly between the 20th and 37th week of gestation; whether it is congenital malformations of the uterus, uterine infections, haemorrhages caused by placenta previa (Read), malformations of the fetus, environmental causes or pregnancy infections, depending on the time of birth, although now science is making great strides, life for premature babies is certainly not easy and the percentage of babies who fails to survive or has severe brain injuries or physical handicaps.

For this reason, in some specific cases, some specialists (gynecologists) decide to intervene with uterine cerclage.

- Is there a specific test to calculate the risk of premature birth?
About 0,6% of pregnant women not only give birth before the expected date of delivery but even before the 32nd week. When repeated episodes of abortion or preterm births occur in the clinical history, it is possible to investigate and predict preterm birth through the cervicometry, that is, the measurement of the length of the uterine cervix, which is performed transvaginally. If the length, around 24 weeks, is less than 15 mm for single pregnancies and 25 mm for multiple pregnancies, there is a greater risk of having a preterm birth.

ALSO READ: Contractions, how they arise and how they are recognized

- What are the cases in which it is decided to intervene?
The gynecologist may decide to schedule the cerclage or do it in an emergency. Generally it is decided to plan the cerclage and to intervene between the 12th and 16th week of gestation in those women who present in their clinical history repeated miscarriages between the 16th and 20th week pregnancy, premature births and in any case difficulties in carrying a pregnancy to term due to cervical incontinence, or the inability of the uterus to support the weight of the pregnancy (baby, liquids, placenta, etc.), which due to this weight gradually shortens and dilates, triggering an abortion or a highly premature birth. In other cases, however, when, for example, in a fairly early period the mother had to go to the emergency room in the throes of strong uterine contractions with uterus too shortened for that time and with dilation, with the risk therefore that the baby could be born too early where, however, the process of childbirth cannot be stopped pharmacologically, emergency cerclage is done. With the latter one often intervenes also with uterine muscle relaxant drugs designed to reduce contractions (Read) to allow the pregnancy to be "lengthened" at least for the time to be able to carry out the maturation therapy of the baby's lungs or to transfer the mother to a center set up for the treatment of premature babies.

- How does the surgery take place and what exactly is it about?
The cerclage is a small surgery that is performed under general anesthesia, it intervenes by inserting a small circular band in the uterine cervix, designed to "close" it and to prevent this dilating and shortening triggering a premature birth. It is usually removed when the pregnancy is coming to an end, in order to allow the woman to have normal labor.

It can be performed as early as the 12th / 14th week where the clinical history confirming cervical incompetence foresees the possibility of an abortion or an extremely premature birth (before the 32nd week) and therefore it is performed at a level "preventive" or "emergency" at any stage of pregnancy, usually between the 20th and 26th week

ALSO READ: Prevent premature birth

- Will there be any difficulties at the time of delivery?
Absolutely not, because a few weeks before the expiration of the term, or the presumed date of delivery, the band is removed and labor and delivery will take place normally as for all other women.

Some discordant voices
Very popular in the 50s when it was discovered and also in the following decades, the cerclage is now the victim of conflicting opinions and thoughts. By many specialists this technique has now been abandoned because it is argued that the results are too low and that indeed, by intervening, there is even a higher incidence of premature birth! How is this possible, we ask? This is the explanation: the insertion of the band used for the so-called cerclage implies an increased risk of infections which in turn increase the possibility that the waters break spontaneously, spontaneously resulting in a preterm birth. Furthermore, in women with the same level of risk not subjected to cerclage but treated pharmacologically, the result has remained almost the same, which is why many specialists have now abandoned the technique.


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