Cervical Cerclage

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Things you need to know

1.What is ​Cervical Cerclage?
2.Why do you need it?
3.Why cost vary in philippines?
4.Surgery cost range by city
5.Surgery Procedure
6.Recovery
7.Risk and complications
8.FAQ
9.Conclusion

What is Cervical Cerclage​ ?

Cervical cerclage is a surgical procedure to reinforce a weakened or incompetent cervix during pregnancy to prevent premature birth or miscarriage. It involves stitching the cervix closed, typically between 12–24 weeks of gestation, using a strong suture to keep it closed until delivery is planned. Performed under spinal or general anesthesia, it can be done via a transvaginal (McDonald or Shirodkar technique) or transabdominal approach, depending on the case. In the Philippines, cervical cerclage is conducted in obstetrics and gynecology units at hospitals like St. Luke’s Medical Center, The Medical City, Makati Medical Center, Philippine General Hospital (PGH), and Cardinal Santos Medical Center.

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 Philippines?

.

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.
  • 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.
  • 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​

  1. Hospital Stay: 1–2 days; same-day discharge for elective cases.
  2. 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.
  3. Diet: Normal diet; 2–3 liters water daily; high-fiber foods (e.g., fruits, vegetables) to prevent constipation.
  4. 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

.

Looking for Best Hospitals for Cervical Cerclage​

Note: we are not promoting any hospitals

We do not promote any hospitals. All details are sourced from Google and hospital websites. Please verify independently. Start with your surgery—here’s the list of government, budget, and superspecialty hospitals accredited by the Department of Health (DOH), Philippine Health Insurance Corporation (PhilHealth), and Joint Commission International (JCI)

  • click on your city and schedule your surgery now done in good hands.
City Minimum Price (₱) Maximum Price (₱)
Angeles City
Antipolo
Bacolod
Bacoor
Baguio
Butuan
Cagayan de Oro
Caloocan
Cebu City
Dasmariñas
Davao City
General Santos
General Trias
Iligan
Iloilo City
Las Piñas
Makati
Malolos
Manila
Muntinlupa
Parañaque
Pasay
Pasig
Puerto Princesa
Quezon City
San Fernando
San Jose del Monte
Taguig
Valenzuela
Zamboanga City

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.

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, reducing the risk of preterm birth or miscarriage. In the Philippines, cervical cerclage is conducted in obstetrics and gynecology departments at hospitals like St. Luke’s Medical Center, Makati Medical Center, The Medical City, and Philippine General Hospital (PGH), offering advanced care at relatively affordable costs. Understanding the procedure, costs, recovery, risks, and frequently asked questions (FAQs) is essential for Filipino expectant mothers and families 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 (15–20% of recurrent pregnancy losses).

    • Short cervix (<25 mm) detected on transvaginal ultrasound before 24 weeks gestation, with a history of preterm birth or miscarriage (10–15% of high-risk cases).

  • High-Risk Pregnancies:

    • Previous cervical surgery (e.g., cone biopsy, loop electrosurgical excision procedure [LEEP], 5–10% of cases).

    • Multiple pregnancies (e.g., twins, triplets) with a short cervix and prior preterm birth history (5–7%).

  • Emergency Cerclage:

    • Cervical dilation or bulging membranes into the vagina (before 24 weeks) without labor, infection, or rupture of membranes (2–5% of cases).

  • Prophylactic (Elective) Cerclage:

    • Performed at 12–14 weeks gestation based on history of second-trimester loss or preterm birth due to cervical insufficiency (10–15% of cerclage cases).

  • Prevalence in the Philippines: Cervical insufficiency affects ~1–2% of pregnancies, with higher rates among women with prior cervical trauma or multiple gestations. Preterm birth is a significant issue, contributing to ~15% of neonatal deaths locally.

  • Timing: Elective cerclage at 12–14 weeks; emergency cerclage before 24 weeks if viable; not performed after 24 weeks due to increased risks.

The procedure aims to support the cervix, prolong pregnancy to near-term (37 weeks), and reduce the risk of preterm birth (to 10–20% vs. 50–60% without cerclage) or miscarriage.

Why Do Cervical Cerclage Costs Vary in the Philippines?

Costs range from ₱50,000 to ₱200,000, influenced by:

  • Procedure Type:

    • Transvaginal cerclage (McDonald or Shirodkar technique): ₱50,000–₱120,000.

    • Transabdominal cerclage (for failed vaginal cerclage or anatomical issues): ₱120,000–₱200,000.

  • Hospital/Location: Higher costs in Metro Manila private hospitals (e.g., St. Luke’s, Makati Medical Center: ₱80,000–₱200,000); lower in public hospitals like PGH (₱20,000–₱60,000, often subsidized by PhilHealth or PCSO medical assistance).

  • Surgeon’s Expertise: Experienced obstetricians or maternal-fetal medicine specialists charge higher fees.

  • Additional Costs:

    • Pre-op tests (e.g., transvaginal ultrasound, blood tests): ₱5,000–₱15,000.

    • Anesthesia (spinal or general): ₱10,000–₱30,000.

    • Hospital stay (1–2 days; same-day for elective cases): ₱10,000–₱30,000/day.

    • Medications (e.g., tocolytics, progesterone, antibiotics): ₱5,000–₱20,000.

    • Post-op care (e.g., follow-up ultrasounds, progesterone): ₱10,000–₱30,000.

  • Insurance: PhilHealth covers part (e.g., ₱10,000–₱30,000) for high-risk pregnancies; private insurance typically covers medically necessary cases with documented cervical insufficiency. PCSO medical assistance or charity programs may reduce costs for indigent patients. Confirm with your provider.

Cervical Cerclage Procedure

Before Surgery Evaluation:

  • Diagnosis:

    • Transvaginal Ultrasound: Measures cervical length (normal: >25 mm; <25 mm indicates risk, 80–90% of cases use ultrasound for diagnosis).

    • History: Review of prior second-trimester losses or preterm births (painless dilation, 15–20% of cases).

    • Fetal Ultrasound: Confirms fetal viability, gestational age, and excludes anomalies.

    • Blood Tests: Rule out infection (e.g., white cell count, C-reactive protein); check for contraindications (e.g., active labor, ruptured membranes).

  • Preparation:

    • Medications: Tocolytics (e.g., nifedipine) to prevent contractions (10–20% of cases); antibiotics (e.g., cefazolin) if infection risk.

    • Fasting: 4–6 hours if general or spinal anesthesia is used.

    • Consent: Includes risks like preterm labor, infection, or fetal loss.

  • Multidisciplinary Team: Involves obstetrician, maternal-fetal medicine specialist (for high-risk cases), anesthesiologist, and neonatologist (if preterm delivery risk).

Surgical Techniques:

  1. Transvaginal Cerclage (Most Common, 90–95%):

    • Performed under spinal anesthesia (70–80%) or general anesthesia (20–30%), lasting 15–30 minutes.

    • Process:

      • Patient in lithotomy position (legs elevated in stirrups).

      • Cervix exposed using a speculum.

      • A purse-string suture (e.g., Mersilene tape, nylon) is placed around the cervix:

        • McDonald Technique: Suture at the internal os (simpler, 70–80% of cases).

        • Shirodkar Technique: Suture higher, closer to cervico-isthmic junction (20–30%, for shorter cervices).

      • Suture tied to keep cervix closed; excess trimmed.

    • Tools: Speculum, suture material, ultrasound (intra-op to confirm fetal well-being).

  2. Transabdominal Cerclage (Rare, 5–10%):

    • For failed vaginal cerclage or anatomical issues (e.g., extremely short cervix post-conization).

    • Performed via laparotomy or laparoscopy under general anesthesia, lasting 1–2 hours.

    • Suture placed at the cervico-isthmic junction through an abdominal incision.

    • Requires cesarean delivery (suture remains in place).

  3. Emergency Cerclage (2–5%):

    • Performed if cervix is dilated or membranes bulge (before 24 weeks) without labor or infection.

    • Higher risk of complications; requires careful patient selection.

  4. Intraoperative Considerations:

    • Sterile technique to minimize infection risk.

    • Fetal heart rate monitoring pre- and post-procedure.

After Surgery:

  • Observation: 1–2 days in hospital (elective cases); same-day discharge possible for low-risk cases (20–30%). Emergency cases may require longer monitoring.

  • Care:

    • Pain management with oral analgesics (e.g., paracetamol) for mild cramping (1–3 days).

    • Medications: Progesterone (e.g., vaginal suppositories, 200 mg daily) to support pregnancy (50–60% of cases); antibiotics (e.g., cefazolin) if infection risk.

    • Fetal heart rate and uterine activity (contractions) monitored via ultrasound or tocodynamometer.

  • Instructions:

    • Avoid heavy lifting, intercourse, or strenuous activity for 2–4 weeks.

    • Suture removal (vaginal cerclage) at 36–37 weeks unless preterm labor occurs; transabdominal cerclage remains for cesarean delivery.

Recovery After Cervical Cerclage

  • Hospital Stay: 1–2 days (elective); same-day discharge for low-risk cases; 3–5 days for emergency cerclage.

  • Post-Surgery Care:

    • Pain/Cramping: Mild cramping or spotting for 1–3 days; managed with analgesics (e.g., paracetamol); severe pain requires immediate evaluation.

    • Activity: Bed rest for 1–2 days post-procedure; avoid heavy lifting, intercourse, or strenuous activity for 2–4 weeks; light activities (e.g., walking) resume after 2–3 days.

    • Monitoring: Weekly or biweekly transvaginal ultrasounds to check cervical length and fetal growth (until 28 weeks); watch for preterm labor signs (e.g., contractions, bleeding).

    • Medications: Progesterone (if prescribed) continued to reduce preterm labor risk; antibiotics if infection suspected.

    • Diet: Normal diet; 2–3 liters water daily; high-fiber foods (e.g., fruits, vegetables) to prevent constipation (common with progesterone or bed rest).

  • Follow-Up:

    • Visits weekly or biweekly until 28 weeks, then monthly until delivery.

    • Suture removal (vaginal cerclage) at 36–37 weeks in clinic (5–10 minutes, minimal discomfort); transabdominal cerclage requires cesarean delivery.

  • Recovery timeline: Most resume light activities in 1–2 weeks; pregnancy continues with close monitoring. Success rates: 85–90% of elective cerclages prolong pregnancy to >34 weeks; emergency cerclages have 50–70% success in preventing preterm birth before 28 weeks.

Risks and Complications

  • Surgical Risks:

    • Infection (2–5%): Cervicitis or chorioamnionitis; may trigger preterm labor or require antibiotics/suture removal.

    • Bleeding (1–3%): Usually mild vaginal spotting; severe bleeding is rare but may need intervention.

    • Suture Displacement (1–2%): Suture loosens or tears through cervix; may require re-suturing or pregnancy loss.

  • Pregnancy Complications:

    • Preterm Labor (5–10%): Cerclage may trigger contractions; managed with tocolytics (e.g., nifedipine).

    • Premature Rupture of Membranes (PROM, 1–5%): Leads to preterm delivery or pregnancy loss; higher risk in emergency cerclage.

    • Cervical Laceration (1–3%): During suture placement or removal; may cause scarring or bleeding.

  • Transabdominal-Specific (5–10%):

    • Higher risk of bleeding, uterine injury, or infection due to abdominal approach.

    • Requires cesarean delivery for current and future pregnancies.

  • Fetal Risks:

    • Fetal loss: 1–2% in elective cerclage; 5–10% in emergency cerclage due to higher baseline risk.

  • Long-Term:

    • Cervical scarring (<1%): May affect future pregnancies or cervical dilation in labor.

    • Recurrence of cervical insufficiency (10–20%): May need cerclage in future pregnancies.

  • Report fever, heavy bleeding, leaking fluid, severe cramping, or contractions promptly.

Frequently Asked Questions (FAQs)

What causes cervical insufficiency?
Prior cervical trauma (e.g., cone biopsy, D&C), congenital cervical weakness, or multiple pregnancies; often idiopathic (unknown cause, 50–60% of cases).

Can I avoid cervical cerclage?
Yes, in low-risk cases with close monitoring (weekly ultrasounds) and progesterone (e.g., vaginal suppositories); cerclage is needed for confirmed insufficiency or high-risk history.

Is cervical cerclage painful?
Performed under anesthesia; mild cramping or spotting for 1–3 days post-procedure, managed with analgesics.

How soon can I resume activities?
Light activities (e.g., walking): 2–3 days; normal routines: 1–2 weeks; avoid heavy lifting, intercourse, or strenuous activity until delivery.

Is cervical cerclage covered by insurance in the Philippines?
PhilHealth covers part (e.g., ₱10,000–₱30,000) for high-risk pregnancies; private insurance typically covers medically necessary cases with ultrasound evidence. PCSO assistance may apply. Confirm with your provider.

What are the signs of complications post-procedure?
Fever, heavy bleeding, leaking fluid, severe cramping, or contractions require immediate medical attention.

Can I deliver vaginally after cerclage?
Vaginal cerclage: Yes, after suture removal at 36–37 weeks. Transabdominal cerclage: Requires cesarean delivery.

What lifestyle changes are needed post-procedure?
Avoid heavy lifting, intercourse, or strenuous activity for 2–4 weeks; monitor for preterm labor signs, use progesterone if prescribed, maintain a healthy diet, and attend regular check-ups.

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 (85–90% success in elective cases). The Philippines’ top hospitals (St. Luke’s, Makati Medical Center, PGH) offer quality care at costs ranging from ₱50,000 to ₱200,000, often partially covered by PhilHealth or private insurance. Understanding the procedure, costs, recovery, risks, and FAQs empowers expectant mothers to approach cerclage confidently. For concerns like prior pregnancy loss or a short cervix, consult a board-certified obstetrician or maternal-fetal medicine specialist for personalized guidance and optimal outcomes.

Looking for Best Hospitals for Cervical Cerclage

Note: we are not promoting any hospitals

We do not promote any hospitals. All details are sourced from Google and hospital websites. Please verify independently. Start with your surgery—here’s the list of government, budget, and superspecialty hospitals accredited by the Department of Health (DOH), Philippine Health Insurance Corporation (PhilHealth), and Joint Commission International (JCI)

  • click on your city and schedule your surgery now done in good hands.
City Minimum Price (₱) Maximum Price (₱)
Angeles City
20,000
80,000
Antipolo
20,000
80,000
Bacolod
20,000
80,000
Bacoor
20,000
60,000
Baguio
20,000
80,000
Butuan
20,000
60,000
Cagayan de Oro
20,000
80,000
Caloocan
20,000
60,000
Cebu City
30,000
100,000
Dasmariñas
20,000
60,000
Davao City
30,000
100,000
General Santos
20,000
80,000
General Trias
20,000
60,000
Iligan
20,000
80,000
Iloilo City
20,000
80,000
Las Piñas
20,000
80,000
Makati
30,000
100,000
Malolos
20,000
60,000
Manila
30,000
100,000
Muntinlupa
20,000
80,000
Parañaque
20,000
80,000
Pasay
20,000
80,000
Pasig
30,000
100,000
Puerto Princesa
20,000
80,000
Quezon City
30,000
100,000
San Fernando
20,000
60,000
San Jose del Monte
20,000
60,000
Taguig
30,000
100,000
Valenzuela
20,000
60,000
Zamboanga City
20,000
80,000

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.

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