This video demonstrate How to Perform Cervical Cerclage - Lecture by Dr R K Mishra. Cervical cerclage, also known as a cervical stitch, is a treatment for cervical incompetence or insufficiency, when the cervix starts to shorten and open too early during a pregnancy causing either a late miscarriage or preterm birth. Treatment for cervical incompetence is a surgical procedure called cervical cerclage, in which the cervix is sewn closed during pregnancy. The cervix is the lowest part of the uterus and extends into the vagina.

Cervical cerclage is a surgical procedure used to prevent preterm birth or miscarriage in women with cervical insufficiency. In his insightful lecture, Dr. R.K. Mishra, a renowned laparoscopic and gynecologic surgeon, elaborates on the step-by-step approach to performing cervical cerclage safely and effectively.

Understanding Cervical Cerclage

Cervical cerclage involves placing a strong suture around the cervix to reinforce it and prevent premature opening during pregnancy. It is typically indicated in women with a history of second-trimester pregnancy loss, cervical incompetence detected via ultrasound, or previous cervical trauma.

Preoperative Preparation

Dr. Mishra emphasizes the importance of meticulous preoperative evaluation:

1. Patient Assessment: Review obstetric history, prior surgeries, and risk factors for cervical insufficiency.

2. Ultrasound Evaluation: Assess cervical length and anatomy to confirm the indication for cerclage.

3. Informed Consent: Explain procedure benefits, risks, and potential complications.

4. Anesthesia: Typically performed under regional or general anesthesia.

Step-by-Step Procedure

Dr. Mishra outlines a systematic approach:

1. Patient Positioning: Place the patient in the lithotomy position for optimal access to the cervix.

2. Cervical Exposure: Use a speculum to visualize the cervix clearly.

3. Selection of Suture: Non-absorbable suture material is preferred, such as Mersilene tape.

4. Placing the Suture:

   • McDonald Technique: A purse-string suture is placed around the cervix.

   • Shirodkar Technique: The suture is placed deeper, sometimes requiring dissection of cervical tissue for better support.

5. Tying the Suture: Ensure the knot is secure but not overly tight to avoid tissue damage.

6. Confirming Placement: The cervix should remain closed, and hemostasis should be achieved.

Postoperative Care

Dr. Mishra highlights essential postoperative steps:

• Observation: Monitor for vaginal bleeding or signs of infection.

• Activity Modification: Advise limited physical activity for a few days.

• Follow-Up: Cervical length may be monitored via ultrasound. The suture is usually removed around 36–37 weeks of gestation or earlier if labor begins.

Complications and Management

Although cervical cerclage is generally safe, Dr. Mishra cautions about potential complications:

• Preterm labor or rupture of membranes

• Cervical infection or bleeding

• Suture displacement or failure

Prompt recognition and management of these complications are critical to ensure maternal and fetal safety.

Conclusion

Dr. R.K. Mishra’s lecture on cervical cerclage provides a comprehensive roadmap for gynecologists and obstetricians seeking to master this procedure. The key to success lies in careful patient selection, precise surgical technique, and vigilant postoperative care. With proper execution, cervical cerclage can significantly improve pregnancy outcomes in women with cervical insufficiency.