Understanding Cervical Incompetence
and Cerclage
Information to help you prepare for your procedure
What is Cervical Incompetence?
Cervical incompetence means your cervix (the opening of your uterus) may open too early during pregnancy.
The cervix normally stays closed and firm until late in pregnancy. With cervical incompetence, it may start to open in the second trimester without contractions or pain.
In simple terms: Think of your cervix like a door that should stay locked until the baby is ready. With cervical incompetence, that door may start to unlock too soon.
This condition can be managed with careful monitoring and treatment. You are in the right place.
Understanding Your Cervix
Your cervix is at the bottom of your uterus. It connects your uterus to your vagina.
During pregnancy, a healthy cervix stays long, closed, and firm to keep your baby safe inside the uterus.
Why Does This Happen?
Several factors can lead to cervical incompetence:
- Previous pregnancy loss in the second trimester
- Previous preterm birth (baby born before 37 weeks)
- Previous cervical surgery or procedures
- Cervical injury from a past delivery
- Naturally shorter cervix
This is not caused by anything you did wrong. It is a medical condition we can treat together.
What is Cervical Funneling?
Funneling happens when the top part of the cervix (near the baby) starts to open while the bottom part stays closed.
We can see this on ultrasound. It tells us the cervix is under stress and may need support.
How We Monitor Your Cervix
We use ultrasound to measure your cervical length.
A normal cervix is usually 3 to 5 centimeters long in the second trimester.
If your cervix gets shorter than 2.5 centimeters, we may recommend a cerclage.
Why Does This Matter?
An incompetent cervix can lead to:
- Preterm birth (baby born too early)
- Premature rupture of membranes (water breaking early)
- Second trimester pregnancy loss
The good news: Early detection and treatment with cerclage can significantly improve outcomes. Many women with cerclage carry their babies to full term or near full term.
What is a Cerclage?
A cerclage is a stitch or suture placed around your cervix to help keep it closed during pregnancy.
Think of it as: A supportive band that helps your cervix stay closed and strong, like reinforcing a door to keep it from opening.
The cerclage provides extra support to help you carry your pregnancy longer.
Types of Cerclage Placement
There are different ways to place a cerclage:
- McDonald cerclage: A simpler purse-string stitch (most common)
- Shirodkar cerclage: Placed higher in the cervix
- Transabdominal cerclage: Placed through the abdomen (rarely needed)
Your doctor will recommend the best type for your situation.
When is Cerclage Placed?
Planned Cerclage
Placed between 12 to 14 weeks if you have a history of:
- Previous second trimester loss
- Previous preterm birth
Ultrasound-Indicated
Placed between 16 to 24 weeks if:
- Your cervix shortens on ultrasound
- Funneling is seen
Earlier placement is usually better, but cerclage can help even when placed later in some cases.
What to Expect During the Procedure
- Anesthesia: You will receive spinal or epidural anesthesia. You will be awake but will not feel pain.
- Duration: The procedure usually takes 15 to 30 minutes.
- Method: The stitch is placed through the vagina (in most cases).
- Hospital stay: Most women go home the same day or stay one night.
This is a common procedure. Your surgical team has extensive experience performing cerclages.
What Happens After Cerclage?
Recovery
- Mild cramping or spotting is normal for a few days
- Rest at home for 2 to 3 days
- Avoid heavy lifting and strenuous activity
- Pelvic rest (no intercourse) as recommended by your doctor
Follow-up Care
- Regular ultrasounds to check your cervix
- Prenatal visits every 2 to 4 weeks
- Monitoring for signs of preterm labor
We Will Monitor You Closely
After cerclage placement, we will watch for:
- Cervical length on ultrasound
- Signs of infection
- Contractions or preterm labor
- Your baby's growth and wellbeing
Call Your Doctor If You Experience:
Contractions, pelvic pressure, vaginal bleeding, fluid leakage, fever, or severe pain
You are part of our team. We want to hear from you if anything feels wrong.
Success Rates and What They Mean
75-90%
Of women with cerclage carry their pregnancy beyond 32 weeks
Success depends on several factors:
- How early the cerclage is placed
- Your cervical length at the time of placement
- Whether membranes are bulging
- Your specific medical history
Even if you cannot carry to full term, cerclage often helps you gain several more weeks. Every week matters for your baby's development.
Cerclage Removal
The cerclage is usually removed between 36 to 37 weeks of pregnancy.
What to Expect:
- Removal is a simple office procedure
- No anesthesia needed in most cases
- Takes only a few minutes
- Labor may start soon after, or you may wait several more weeks
If you go into labor before 36 weeks, we may remove it earlier or leave it in place depending on your situation.
What You Can Do
Physical Care
- Follow activity restrictions
- Stay hydrated
- Get adequate rest
- Attend all appointments
Emotional Care
- Ask questions anytime
- Seek support from loved ones
- Consider a support group
- Be kind to yourself
Taking care of your emotional health is just as important as physical care. We are here to support you both.
You Are Not Alone
Your care team includes:
- Maternal-Fetal Medicine specialists
- Your OB/GYN
- Ultrasound technologists
- Nurses and support staff
We work together to give you and your baby the best possible care.
Questions and Next Steps
Before Your Procedure:
- Write down any questions you have
- Arrange for someone to drive you home
- Follow pre-procedure instructions
- Bring a list of your medications
Common Questions to Ask:
- What type of cerclage will I have?
- What activity restrictions will I need?
- How often will I have ultrasounds?
- When should I call with concerns?
There are no silly questions. We want you to feel informed and confident.
Important Things to Remember
Every pregnancy is different. Your experience may not match what you read online or hear from others.
Small gains matter. Every day and week your baby stays inside helps them grow stronger.
You are doing great. Seeking care and staying informed shows your commitment to your baby.
We are partners in this journey. Together, we will work toward the healthiest outcome for you and your baby.
We Are Here for You
Thank you for taking the time to learn about cerclage.
Please reach out to your care team with any questions or concerns.
Remember: You are not alone in this journey.
