Also called Cervical Cerclage
If this applies to you, Dr Gibb will carry out a full analysis to find out whether weakness of the cervix (cervical incompetence) is playing a role.
Other causes of mid-trimester pregnancy loss and pre-term birth also have to be considered – for example, twins and higher order multiple pregnancy, abnormal shape of the womb, recurrent bleeding, infections, excessive amniotic fluid with fetal abnormality or monochorionic twins. A history of cervical cone biopsy and cervical amputation is also important as it can help decide the type of treatment needed.
Cervical Suture – also called Cervical Cerclage – can help prevent a miscarriage in certain cases where cervical weakness is playing a role. A cervical suture is a nylon tape stitch placed around the upper part on the cervix to lengthen and strengthen it. There are three types of cervical suture: McDonald Suture, Shirodkar Suture and Transabdominal Suture.
A McDonald Suture is done by most doctors. It is the easiest suture to insert with the least risk. However, it is placed low down on the cervix and is probably the least effective in a difficult case. There is limited evidence about how effective this type of suture is.
A Shirodkar Suture is placed in a higher position on the cervix. It requires greater expertise to carry it out, and there is a greater risk of bleeding. However, once it is in place it is likely to be more effective and there is less risk of infection compared with a McDonald suture. Some doctors use this type of suture when a previous McDonald Suture has failed. Dr Gibb has extensive experience of doing a Shirodkar Suture in women who are at particular risk of miscarriage.
A Transabdominal Suture is used for women who have had their cervix removed by extensive cone biopsy or amputation due to early-stage cancer. These women (some of whom may have had a suture inserted vaginally) may then have had a miscarriage in mid-pregnancy or a premature birth. A Transabdominal Suture is inserted by making an incision (cut) through the abdomen, above the pubic area. This type of suture can be inserted at 11-12 weeks of pregnancy, after an early scan has confirmed that the pregnancy is normal. After this operation, most women can then resume their normal life until a planned Caesarean section at 37 weeks. If serious pregnancy complications arise before the baby is viable (at 24 weeks), the suture can be removed through the vagina (rather than having a second abdominal operation). At Caesarean section for a healthy baby, the suture is left in place. One of Dr Gibb’s patients has had three babies with the suture in place throughout all three pregnancies. About 40 women have had two babies.
Dr Gibb's results are published in the British Journal of Obstetrics and Gynaecology (1995); 102: 802-806. Transabdominal cervicoisthmic cerclage in the – management of recurrent second trimester miscarriage and preterm delivery by Donald M.F. Gibb and Debeer A. Salaria
For a wider review of Cervical Cerclage, see: Cervical cerclage, by V Palaniappan and D Gibb, in The Fetal and Maternal Medicine Review (1999); 11: 55-68.