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Transabdominal Cervical Suture

Transabdominal Cervical Suture is a highly specialist operation. Few doctors have the skill and experience necessary to conduct this procedure – but it can prove life-saving for a baby, and ensure successful future pregnancies for a woman.

What is a Transabdominal Cervical Suture and who is it suitable for?
A Cervical Suture is a nylon tape stitch placed around the upper part of the cervix to lengthen and strengthen it, assisting safe pregnancy.

A Cervical Suture may be an appropriate procedure for a woman with weakness in her cervix, or what is known in medical terms as Cervical Incompetence or more recently Cervical Weakness.

Video: Transabdominal Cervical Suture
(Click image to play)

In the case of this condition, the cervix may open before a baby is carried to term, increasing the risk of miscarriage, or a possible premature birth where the child may suffer from handicap or in the worst cases may not survive.

There are three types of cervical suture:

  • McDonald Suture,
  • Shirodkar Suture and
  • Transabdominal Suture.

A Transabdominal Cervical Suture is the rarest and most specialised cervical suture procedure and is typically required in a woman who has previously had surgery to her cervix, usually for abnormal cervical smears or even cancer. This has often been followed by late miscarriage (16-24 weeks pregnancy) or extreme early premature birth (24-28 weeks of pregnancy). On pelvic examination the vaginal portion of the cervix may be severely damaged or absent.

In this case the only options are to do nothing – which is very risky – or to operate through the tummy to place a cervical suture at the very top of the remaining cervix, just below the uterine body (Transabdominal Cervical Suture).

How does a Transabdominal Cervical Suture work?
A Transabdominal Cervical Suture requires general anaesthesia and two to three days in hospital.

It can be done as an open procedure at about 12 weeks in pregnancy (common), as a procedure for a non-pregnant woman prior to conception (becoming more common), or as a key hole procedure when not pregnant (becoming more common). It is not really feasible to do it as a key hole (laparoscopic) procedure when pregnant.

The traditional open operation is performed under general anaesthesia through a transverse suprapubic (bikini line) incision. A bladder catheter to drain urine is necessary during the operation and for 24 hours.

The operation takes about 60 minutes depending on other factors such as obesity and scarring from previous surgery. Early mobilisation after this procedure is encouraged and the woman can be ready to go home in 48-72 hours. The baby’s heart beat can be checked just before discharge for reassurance.

After two weeks rest the woman can return to reasonable activities including work. She should be followed up in a specialist consultant clinic. If a complication occurs then experienced opinion should be obtained from the person who performed the operation.

The pregnancy can be monitored normally and all being well proceed to a caesarean delivery at 37-39 weeks gestation. The only reasonable method of delivery is caesarean section. The stitch should be left in place for a future pregnancy or pregnancies. When child bearing is complete the suture should ideally be removed.

What are the possible risks of Transabdominal Cervical Suture during pregnancy?
The obvious risk of performing this as an open procedure during pregnancy is that miscarriage may occur. Additionally there may be bleeding or possibly damage to adjoining structures. However, the fact that the pregnancy has already reached 12 weeks without miscarriage is reassuring, and access to the relevant area is easier because of the relaxing effect of pregnancy hormones.

We thank Dr Donald Gibb of The Birth Company, for providing specialist knowledge for this article.

Dr Gibb began performing Transabdominal Cervical Sutures thirty years ago and has performed more than 80 cases. He is now one of Europe’s foremost experts on this highly specialist procedure.

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