Once it's been diagnosed, a woman undergoes treatment for future pregnancies, which involves a surgical procedure called a cerclage. The cerclage is a purse-string stitch that acts as an cinch to keep the cervix from dilating. It's placed between 12-15 weeks gestation. The stitch is inserted surgically while the patient is under spinal, epidural, or general anesthesia. The procedure can be considered outpatient surgery, although there's a chance that you might need to spend the night in the hospital if you experience cramping or extensive bleeding.
• The McDonald stitch is the most common. It's the easiest to use and allows vaginal delivery. The stitch is woven in and out of the cervix and pulled tightly and tied to keep the cervix closed.
• The Shirodkar stitch can be permanent (requiring a cesarean section) or be removed near term. The stitch starts at a 12 o'clock position, worked through the cervix to the 6 o'clock position, ending back in the 12 o'clock position on the other side of the cervix. It's pulled tightly and tied to keep the cervix closed.
• An abdominal stitch is used when there is too little cervix to work with. The upper and lower part of the cervix are stitched together. A cesarean section is required for delivery.
• The Hefner cerclage is commonly used when IC is diagnosed later in pregnancy. It has an added benefit when there is little cervix to work with. This cerclage is removed closer to term as well.
• The Lash cerclage is the only type that's placed prior to pregnancy. This stitch is used in cases of extensive cervical trauma or an anatomical defect. It's permanent and requires a cesarean delivery.
Once the cerclage has been placed, you'll be put on bedrest for a period of 24-72 hours. You could have your regular and sexual activity restricted or have bedrest continue if complications occur. Look for signs of increased discharge with odor, spotting, heavy bleeding, burning, itching or a fever over 101. If you notice any of these symptoms, contact your physician immediately.
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