Cervical Cerclage
What is Cervical Cerclage?
Cervical cerclage is a surgical procedure to reinforce a weakened cervix by placing a stitch (suture) around it to prevent premature birth or pregnancy loss in women with cervical insufficiency. It is typically performed during pregnancy to keep the cervix closed until delivery. In India, cervical cerclage is conducted in obstetrics and gynecology departments at hospitals like Apollo, Fortis, Medanta, and AIIMS, offering advanced care at affordable costs. Understanding the procedure, costs, recovery, risks, and frequently asked questions (FAQs) is essential for expectant mothers and families in India to make informed decisions.
Why do you need Cervical Cerclage?
Cervical cerclage is indicated for:
- Cervical insufficiency (incompetent cervix):
- History of painless cervical dilation leading to second-trimester miscarriage or preterm birth.
- Short cervix (<25 mm) detected on ultrasound (transvaginal) before 24 weeks gestation, with a history of preterm birth.
- High-risk pregnancies:
- Previous cerclage or cervical surgery (e.g., cone biopsy, LEEP).
- Multiple pregnancies (e.g., twins) with a short cervix and prior preterm birth history.
- Emergency cerclage:
- Cervical dilation or membranes bulging into the vagina (before 24 weeks) without labor or infection.
- Prophylactic cerclage:
- Elective, based on history (e.g., prior second-trimester loss due to cervical insufficiency), typically at 12–14 weeks gestation.
The procedure aims to support the cervix, prolong pregnancy, and reduce the risk of preterm birth or miscarriage, allowing the baby to develop closer to term.
Why Do Cervical Cerclage Costs Vary in India?
Costs range from ₹30,000 to ₹1.5 lakh:
- Procedure Type: Transvaginal (₹30,000–₹80,000); transabdominal (₹80,000–₹1.5 lakh).
- Hospital/Location: Higher in metro cities (Apollo, Fortis); lower in government hospitals (AIIMS, ₹10,000–₹30,000).
- Surgeon’s Expertise: Experienced obstetricians charge more.
- Additional Costs: Ultrasound (₹2,000–₹5,000), hospital stay (₹5,000–₹20,000/day), medications.
- Insurance: Often covered for high-risk pregnancies; confirm with your provider.
Cervical Cerclage Procedure
- Before Surgery Evaluation:
- Diagnosis:
- Transvaginal ultrasound: Measures cervical length (normal: >25 mm; <25 mm indicates risk).
- History: Review of prior pregnancy losses or preterm births (esp. painless dilation).
- Fetal ultrasound: Confirms viability and excludes anomalies.
- Blood tests: Rule out infection (e.g., white cell count, CRP); check for contraindications.
- Medications: Tocolytics (e.g., nifedipine) to prevent contractions; antibiotics if infection risk.
- Consent: Risks, including preterm labor, are explained.
- Diagnosis:
- Surgical Techniques:
- Transvaginal Cerclage (Most Common):
- Performed under spinal or general anesthesia, lasting 15–30 minutes.
- The patient is in the lithotomy position (legs elevated in stirrups).
- The cervix is exposed using a speculum.
- A purse-string suture (e.g., Mersilene tape or nylon) is placed around the cervix at the internal os (McDonald technique) or higher (Shirodkar technique).
- The suture is tied to keep the cervix closed; excess suture is trimmed.
- Transabdominal Cerclage (Rare):
- For failed vaginal cerclage or anatomical issues (e.g., very short cervix).
- Performed via laparotomy or laparoscopy, lasting 1–2 hours.
- A suture is placed at the cervico-isthmic junction through an abdominal incision.
- Requires cesarean delivery (suture not removed).
- Emergency Cerclage:
- Done if the cervix is dilated or membranes are bulging; higher risk of complications.
- Intraoperative Tools:
- Ultrasound: Confirms fetal well-being during the procedure.
- Sterile technique: Reduces infection risk.
- Transvaginal Cerclage (Most Common):
- After Surgery:
- Observation: 1–2 days in the hospital; same-day discharge for elective cases.
- Pain management: Analgesics (e.g., paracetamol) for mild cramping.
- Medications: Progesterone (e.g., vaginal suppositories) to support pregnancy; antibiotics (e.g., cefazolin) if infection risk.
- Monitoring: Fetal heart rate and uterine activity (contractions) checked.
- Suture removal: At 36–37 weeks (vaginal cerclage) or at cesarean delivery (transabdominal).
Recovery After Cervical Cerclage
- Hospital Stay: 1–2 days; same-day discharge for elective cases.
- Post-Surgery Care:
- Pain: Mild cramping or spotting for 1–3 days, managed with analgesics.
- Activity: Bed rest for 1–2 days; avoid heavy lifting, intercourse, or strenuous activity for 2–4 weeks.
- Monitoring: Weekly/biweekly ultrasounds to check cervical length and fetal growth.
- Signs to watch: Contractions, vaginal bleeding, leaking fluid (ruptured membranes), or fever.
- Progesterone: Continued (if prescribed) to reduce preterm labor risk.
- Diet: Normal diet; 2–3 liters water daily; high-fiber foods (e.g., fruits, vegetables) to prevent constipation.
- Follow-Up:
- Visits weekly or biweekly until 28 weeks, then as needed.
- Suture removal at 36–37 weeks (vaginal cerclage) unless preterm labor occurs earlier.
Most resume normal light activities in 1–2 weeks; pregnancy continues with monitoring. Success rates: 85–90% for prolonging pregnancy in high-risk cases; preterm birth risk reduced to 10–20% (vs. 50–60% without cerclage).
Risks and Complications
- Surgical Risks:
- Infection (2–5%): Cervicitis, chorioamnionitis; may lead to preterm labor.
- Bleeding (1–3%): Usually mild; rarely requires intervention.
- Suture displacement (1–2%): May need re-suturing.
- Pregnancy Complications:
- Preterm labor (5–10%): Cerclage may trigger contractions.
- Premature rupture of membranes (PROM, 1–5%): May lead to preterm delivery.
- Cervical laceration (1–3%): During suture placement or removal.
- Transabdominal-Specific:
- Higher risk of bleeding or uterine injury (2–5%).
- Requires cesarean delivery.
- Fetal Risks: Fetal loss (1–2% in elective cases; 5–10% in emergency cerclage).
- Long-Term: Cervical scarring (rare, <1%), potentially affecting future pregnancies.
Report fever, heavy bleeding, leaking fluid, or contractions promptly.
Frequently Asked Questions (FAQs)
What causes cervical insufficiency?
Prior cervical trauma (e.g., cone biopsy, D&C), congenital weakness, or multiple pregnancies; often unknown.
Can I avoid cerclage in future pregnancies?
Yes, with close monitoring (ultrasounds) and progesterone; cerclage is only for confirmed insufficiency or high-risk cases.
Is cerclage painful?
Minimal discomfort under anesthesia; mild cramping post-procedure for 1–3 days.
How soon can I resume activities?
Light activities in 1–2 weeks; avoid strenuous activity until delivery.
Is cervical cerclage covered by insurance in India?
Often covered for high-risk pregnancies; confirm with your provider.
Signs of complications?
Fever, heavy bleeding, leaking fluid, severe pain, or contractions.
Will I deliver normally after cerclage?
Vaginal cerclage: Yes, after suture removal at 36–37 weeks. Transabdominal: Requires cesarean delivery.
Lifestyle changes post-procedure?
Avoid heavy lifting/intercourse for 2–4 weeks, monitor for preterm labor signs, attend regular check-ups, and maintain pelvic rest if advised.
Conclusion
Cervical cerclage is an effective procedure to support high-risk pregnancies, significantly reducing the risk of preterm birth or miscarriage in women with cervical insufficiency. India’s top hospitals (Apollo, Fortis, AIIMS) offer affordable, expert care. Understanding the procedure, costs, recovery, risks, and FAQs helps expectant mothers approach cerclage confidently. Consult an obstetrician for personalized guidance and optimal outcomes.
Looking for Best Hospitals for Cervical Cerclage
Note: we are not promoting any hospitals
we are not promoting any hospitals we sourced all the details from google and hospitals website, please verify and start with your surgery here we go the list includes government, budget and superspeciality hospitals accreditation bodies are the National Accreditation Board for Hospitals and Healthcare Providers (NABH) and the Joint Commission International (JCI)
- click on your city and schedule your surgery now done in good hands.
| City | Minimum Price (₹) | Maximum Price (₹) |
|---|---|---|
Agra |
30,000 |
90,000 |
Ahmedabad |
35,000 |
1,00,000 |
Ajmer |
30,000 |
90,000 |
Aligarh |
30,000 |
90,000 |
Allahabad |
30,000 |
90,000 |
Amritsar |
32,000 |
95,000 |
Aurangabad |
32,000 |
95,000 |
Bangalore |
35,000 |
1,00,000 |
Bareilly |
30,000 |
90,000 |
Belgaum |
32,000 |
95,000 |
Bhopal |
32,000 |
95,000 |
Bhubaneswar |
32,000 |
95,000 |
Bikaner |
30,000 |
90,000 |
Chandigarh |
35,000 |
1,00,000 |
Chennai |
35,000 |
1,00,000 |
Coimbatore |
35,000 |
1,00,000 |
Dehradun |
32,000 |
95,000 |
Delhi |
35,000 |
1,00,000 |
Dhanbad |
30,000 |
90,000 |
Durgapur |
30,000 |
90,000 |
Faridabad |
35,000 |
1,00,000 |
Ghaziabad |
35,000 |
1,00,000 |
Gorakhpur |
30,000 |
90,000 |
Guntur |
32,000 |
95,000 |
Gurgaon |
35,000 |
1,00,000 |
Guwahati |
32,000 |
95,000 |
Gwalior |
30,000 |
90,000 |
Hyderabad |
35,000 |
1,00,000 |
Indore |
32,000 |
95,000 |
Jabalpur |
30,000 |
90,000 |
Jaipur |
35,000 |
1,00,000 |
Jalandhar |
32,000 |
95,000 |
Jamshedpur |
32,000 |
95,000 |
Jodhpur |
30,000 |
90,000 |
Kanpur |
30,000 |
90,000 |
Kochi |
35,000 |
1,00,000 |
Kolkata |
35,000 |
1,00,000 |
Kollam |
32,000 |
95,000 |
Lucknow |
32,000 |
95,000 |
Ludhiana |
35,000 |
1,00,000 |
Madurai |
32,000 |
95,000 |
Mangalore |
32,000 |
95,000 |
Meerut |
30,000 |
90,000 |
Moradabad |
30,000 |
90,000 |
Mumbai |
35,000 |
1,00,000 |
Mysore |
35,000 |
1,00,000 |
Nagpur |
32,000 |
95,000 |
Nashik |
32,000 |
95,000 |
Navi Mumbai |
35,000 |
1,00,000 |
Noida |
35,000 |
1,00,000 |
Patna |
30,000 |
90,000 |
Pune |
35,000 |
1,00,000 |
Raipur |
32,000 |
95,000 |
Rajkot |
32,000 |
95,000 |
Ranchi |
30,000 |
90,000 |
Surat |
35,000 |
1,00,000 |
Thane |
35,000 |
1,00,000 |
Vadodara |
32,000 |
95,000 |
Varanasi |
30,000 |
90,000 |
Visakhapatnam |
32,000 |
95,000 |
Disclaimer
This information is sourced from open platforms and is for general awareness only. Costs may vary based on individual cases. Please consult a qualified doctor for medical advice and explore options within your budget before deciding on the procedure.