Is a cervical cerclage required in the next pregnancy?

Question

Hello doctor,

I need your opinion regarding my future pregnancy. Five years ago, I gave birth to my son and had to have an emergency C-section. The doctor's report read 'upon entering the abdominal cavity, the patient was found to have a large uterine window consistent with a uterine rupture. However, there was a small thin area covered by serosa, with a blood clot underneath. The rupture extended along the upper right side into the right broad ligament and round ligament. The incision was closed in two layers, and most of the extension areas were closed and imbricated in two layers as well.' My question to you is with all I went through with my son, would you recommend that I get a cerclage if I decide to have another baby or will I be alright without one?

Answer 1

Hello,

Welcome to icliniq.com.

You can definitely have a baby. The spontaneous tear in the uterus could be due to multiparity, baby weight of greater than 9 lbs, vaginal manipulations during labor, prolonged labor or excessive and uncontrolled use of oxytocin infusion. The cervix is not directly involved. So, in your case, a cervical cerclage is not indicated at all. If by chance, you enter into labor pains at home, or break waters in an unfavorable condition or even if the preterm pain starts, the cervix will dilate and let your baby out. But, if you close it with a band as done in a cerclage, then the baby will come out through the scar. You will lose your baby and your uterus, and if not on a surgery table soon, your life too. A cerclage is indicated only in the case of a cervical insufficiency if you had a history of painless dilatation of cervix, and the cervix gives way. This stitch will only close the internal os of the cervix. It will not strengthen the cervix. So, I would suggest you frequent check-ups during your pregnancy, and a planned cesarean at 37 to 38 weeks.

Hope I have been of help to you. Do write back in case of more queries. All the best.