Almost two million women must undergo uterine or cervical cerclage every year, a very common gynecological surgery that involves closing the cervix in cases where cervical insufficiency or incompetence is demonstrated, that is, a difficulty of the cervix to stay closed until delivery.
The causes can be varied and the treatment consists in suturing and tying the cervix to avoid abortion or premature delivery, a risk-free practice. A new study questions the type of suture used to perform uterine cerclage, since they believe it could have more risks than benefits. As published in the scientific journal Science Traslational of Medicine, the use of one type of suture versus another is associated with a threefold risk of fetal death and almost twice the risk of premature delivery.
Suture thread
In the study, conducted with 678 pregnant women who received a cervical cerclage designed to prevent premature delivery, the use of a braided suture versus a monofilament suture is associated with a three times greater risk of death of the fetus and almost double the risk of having a preterm birth.
A braided suture is used in 80 percent of the interventions, since it is stronger and easier to work with. But because it is thicker and its structure similar to a gear, alter the vaginal microbiota favoring the growth of potentially dangerous bacteria in the cervix, and prevents, in turn, that of Lactobacillus species, essential for maintaining a healthy vaginal microbiota.
In women who received braided cerclage, these alterations were also accompanied by a inflammatory answer.
The study authors estimate that changing the braided suture with the monofilament suture in the cervical cerclage would prevent about 170,000 premature births and 172,000 fetal deaths each year worldwide.
Cerclage Risks
Sutures are removed near the ninth month of pregnancy. If contractions appear before reaching term, it may be necessary to remove it before due to the risk of tearing and the consequent hemorrhage.
According to the World Health Organization (WHO), cervical cerclage is a invasive procedure with an intrinsic risk of pregnancy loss. Therefore, it should only be performed in high-risk cases where there is a cervical factor during the second and third trimesters of pregnancy.
Between 70% and 90% of women who practice cerclage give birth to a healthy baby. However, it is not clear how many of these women really needed a cerclage. There are many women with a short or weak cervix who choose not to have surgery and still give birth to healthy babies.
