Surgical Treatment for Preterm Labor

For some women showing signs of labor before 22 weeks of pregnancy, NYU Langone doctors may recommend cervical cerclage, a surgical procedure that closes the cervix with stitches to prevent the cervix from opening. Cerclage is used to treat cervical insufficiency, a condition in which the cervix slightly opens or shortens, also called effacing, too early in the pregnancy, which can lead to miscarriage or an early labor and raise a woman’s risk of infection.

Your doctor may suggest cerclage if you have had previous preterm births and the cervix is less than 2.5 centimeters in length before week 22 of pregnancy. You may also be a candidate if you have not had a prior preterm birth but have painless dilation of the cervix before week 22 and the membranes that protect the baby are visible during a pelvic exam. Because the risks of cerclage can range from minor to serious, it is offered on a case-by-case basis. It is typically not done in women carrying more than one baby.

A cervical cerclage is performed in the hospital. You are given an epidural, a form of regional anesthesia that’s injected into the back, before the surgeon operates through the vagina to close the cervix with one or more stitches. You can typically return home the day of the procedure. It can take two to three days to recover from the surgery, so your doctor may recommend that you rest before returning to your regular activities.

On average, cerclage adds another seven to eight weeks to a pregnancy. Your doctor removes the stitches before birth. This usually occurs around week 36 of pregnancy, or after the start of contractions or the rupture of the amniotic sac—when the “water” breaks.