Cervical Cerclage
Updated On: December 2, 2024
Anesthetic Approaches
Position - The surgeon generally likes the patient in slight Trendelenburg and the bed raised approximately to eye-level. Pregnancy - These patients are pregnant.
Trendelenburg Position (general considerations): Take precautions for upper airway obstruction or stridor. Avoid excessive fluid administration. OG tube is a good consideration to empty the contents of the stomach. Regurgitation of stomach contents can ulcerate the airway and/or damage the eyes. Consider throat packs and/or eye lubrication to further protect the patient. Brachial nerve injury is also a strong possibility. Be very careful with head and shoulder brace positioning. Peroneal nerve injury is a strong possibility if the patient is also in the lithotomy position. Make sure pressure points are padded. If there's peroneal nerve damage, it will manifest as foot drop. Increased IOP. Take precaution with patients that have glaucoma. Conjunctival swelling will sometimes be irritating to the patient post-operatively. Keep reminding the patient not to rub their eyes. Increased ICP. Cerebral perfusion pressure = MAP-ICP. Make sure you keep the MAP up.
Cervical softening and dilation are a normal part of pregnancy. However, a premature weakened cervix (incompetent cervix or cervical insufficiency) can be caused by cervical damage or an abnormally shaped uterus. Congenital disorders affecting collagen can cause cervical insufficiency. In addition, Past surgical procedures such as a LEEP may also weaken the cervix. Past miscarriages indicate the possibility that the patient has a weak or weakened cervix. Diethylstilbestrol (DES), an estrogen synthetic, if taken before birth has also been linked to this condition. African-American women are at higher risk.
This procedure is designed to help reinforce a weak cervix. If not reinforced, the pressure on the weakened cervix can cause premature delivery. The cervix is reinforced by placing sutures at the opening.