Cervical Cerclage

Understanding Cervical Cerclage: Medical Prevention and Birth Injury Medical Malpractice

A cervical cerclage is a vital surgical procedure that helps prevent premature birth. Doctors place a physical stitch or synthetic tape around the neck of the uterus. This mechanical support holds the cervix closed under the growing weight of a pregnancy. When doctors fail to identify a weak cervix or delay placing a needed cerclage, the consequences can be devastating. Undetected cervical weakness can lead to extremely early labor and severe birth injuries. Accordingly, failure to appropriately place a cervical cerclage can result in a birth injury medical malpractice claim.

Understanding cervical cerclage helps families navigate complex maternal health decisions. The Kopec Law Firm provides this webpage to specifically explore the history, medical indicators, surgical techniques, and potential legal claims surrounding cervical cerclage.

Anatomy and History of Cervical Cerclage – Medical Malpractice

To understand how a cerclage works, firstly, you must understand the anatomy of the female reproductive system.

Anatomy of the Cervix

The cervix is the lower, narrow part of the uterus that connects to the vagina. It acts as the door to the womb. Throughout a healthy pregnancy, the cervix remains long, firm, and also tightly closed. It specifically keeps the developing fetus securely inside the uterus.

During the late third trimester, the cervix naturally softens, shortens (effaces), and opens (dilates) to allow childbirth. However, in some women, the cervical tissue is structurally weak. Under the increasing weight of the baby, the cervix silently opens too early without pain or contractions. Doctors call this condition cervical insufficiency or cervical incompetence.

Normal Cervix vs. Cervical Insufficiency

• Normal Pregnancy (Mid-Trimester): The cervix remains long (greater than 30 mm), firm, and tightly closed to hold the fetus safely inside the uterus.
• Cervical Insufficiency: The cervix shortens (less than 25 mm) and opens prematurely without pain, creating a high risk of early membrane prolapse and labor.

The History of the Procedure

Obstetricians developed surgical methods to fix cervical weakness in the mid-twentieth century:

• 1955 (Shirodkar Technique): A surgical technique that placed a hidden band high on the cervix by making small incisions in the vaginal tissue.
• 1957 (McDonald Technique): A simpler purse-string stitch around the cervix. This method required no complex mucosal incisions, making it easier to place and also remove.
• 1965 (Transabdominal Approach): Doctors developed transabdominal cerclage for women who could not receive a vaginal stitch due to severe cervical damage or past failed procedures.

Why Is a Cerclage Needed – Medical Malpractice

A cerclage reinforces a weak cervix so a mother can carry her baby to full term. Without this support, the weight of the growing fetus causes the cervix to open in the second trimester. This exposes the amniotic sac to vaginal bacteria and can then lead to premature birth or pregnancy loss.

Common Risk Factors and Medical Indications

Doctors look for specific risk factors when evaluating a patient:

• Prior Second-Trimester Losses: A history of painless pregnancy loss or extremely early delivery before 24 weeks.
• Short Cervical Length: Ultrasound measurements showing a cervical length under 25 millimeters before 24 weeks of gestation.
• Prior Cervical Trauma: Past procedures like cone biopsies, Loop Electrosurgical Excision Procedures (LEEP), or severe lacerations from earlier deliveries.
• Congenital Uterine Anomalies: Structural conditions present at birth, such as a bicornuate uterus or DES exposure.

Medical Providers and Diagnosis Methods

Pregnant patients receive care from providers who monitor cervical health.

Doctors Involved

• Obstetricians (OB/GYNs): Primary pregnancy doctors who screen patients, order ultrasounds, and also perform standard vaginal cerclages.
• Maternal-Fetal Medicine Specialists (MFM): High-risk pregnancy doctors who handle complex cases, perform detailed ultrasound surveillance, and also execute advanced transabdominal cerclages.

How Providers Determine Need

Medical providers use three primary approaches to determine if a patient needs a cerclage:

1. History-Indicated (Elective): Doctors place the stitch at 12 to 14 weeks based entirely on the patient’s past history of pregnancy loss.
2. Ultrasound-Indicated: Doctors perform serial transvaginal ultrasounds every two weeks starting at 16 weeks. If the cervical length drops below normal thresholds, they place a stitch.
3. Physical Exam-Indicated (Emergent): A provider discovers during a manual exam that the cervix has already dilated and amniotic membranes are bulging into the vagina.

Failure to appropriately assess the need for a cerclage can be medical malpractice.

Types of Cerclage Procedures and How They Are Performed

Surgeons categorize cerclage procedures by their surgical path and placement method.

1. McDonald Cerclage

• Provider: OB/GYN or MFM Specialist.
• Procedure: Under regional anesthesia (spinal or epidural), the surgeon uses a needle to weave a strong, synthetic suture around the outer neck of the cervix. They then pull the suture tight like a drawstring bag and tie it securely.
• Removal: Doctors easily cut and remove this stitch at 36 to 37 weeks in an outpatient clinic setting to then allow normal vaginal delivery.

2. Shirodkar Cerclage

• Provider: High-risk OB/GYN or MFM Specialist.
• Procedure: The surgeon makes small incisions in the vaginal tissue near the bladder. They push back the tissue to place the stitch much higher up near the internal opening of the cervix. They then stitch the tissue closed over the knot.
• Removal: Requires a careful in-office or surgical procedure to cut the hidden suture before delivery.

3. Transabdominal Cerclage (TAC)

• Provider: MFM Specialist or specialized gynecologic surgeon.
• Procedure: The surgeon reaches the cervix through a lower abdominal incision or laparoscopic assistance. They place a woven synthetic band directly at the junction of the uterus and cervix.
• Removal: This band remains in place permanently. The patient must deliver all future babies via Cesarean section.

Permanent Birth Injuries from Untreated Cervical Insufficiency – Cerclage Medical Malpractice

When a doctor misses cervical weakness and fails to place a cerclage, the baby may be born extremely prematurely (between 16 and 28 weeks). Fragile organs in pre-term infants may not be ready for life outside the womb. This extreme prematurity can cause severe, permanent injuries:

• Cerebral Palsy (CP): Underdeveloped blood vessels in a premature baby’s brain can bleed (intraventricular hemorrhage) or lack oxygen (periventricular leukomalacia). This damage causes lifelong motor disability and muscle control issues.
• HIE: Hypoxic Ischemic Encephalopathy: Premature lungs cannot supply enough oxygen to the brain, causing widespread brain damage.
• Severe Developmental Delays: Cognitive impairments, learning disabilities, and speech difficulties often result from early brain trauma.
• Vision and Hearing Loss: Retinopathy of prematurity (ROP) can cause permanent blindness. Premature infants also face high risks of sensorineural hearing loss.
• Chronic Lung Disease: Immature lungs require mechanical ventilation, which can cause permanent scarring and broncho-pulmonary dysplasia.

Medical Malpractice Claims Related to Cerclage

Medical malpractice occurs when a medical provider strays from accepted standards of care, causing harm to a patient or child. Families affected by a missing or delayed cerclage can often pursue specific legal claims:

1. Misdiagnosis or Failure to Diagnose Cervical Insufficiency

Doctors must take a thorough medical history. If a patient has a clear history of prior mid-trimester losses, failing to diagnose cervical weakness can constitute medical negligence.

2. Failure to Monitor High-Risk Patients

Standards of care require doctors to perform regular transvaginal ultrasound scans for patients at risk. If a doctor fails to order these scans between 16 and 24 weeks, they may miss critical cervical shortening until it is too late to act.

3. Delayed Referral or Action

If an ultrasound reveals a short cervix, a doctor must act promptly. Unreasonable delays in referring the patient to an MFM specialist or scheduling the cerclage procedure can lead to premature rupture of membranes (PROM) or sudden delivery.

4. Surgical Errors and Improper Placement

A doctor can commit malpractice during the procedure itself. Placing the stitch too low, accidentally puncturing the amniotic sac (causing fluid leaks), or injuring the bladder can cause immediate infection, miscarriage, or delivery complications.

5. Failure to Remove the Cerclage Timely – Medical Malpractice

A transvaginal cerclage must be removed before active labor begins or around 36 to 37 weeks. If contractions start and a doctor leaves the stitch in place, strong uterine forces can tear the cervix apart. This can cause severe maternal hemorrhage and fetal Distress.

Seeking Legal Help for Birth Injuries for Cerclage Medical Malpractice

Navigating a birth injury caused by a missed or mishandled cerclage is emotionally and financially exhausting. Medical malpractice claims require detailed reviews of medical records, including prenatal ultrasound records, maternal charts, and also delivery logs. We work alongside medical expert witnesses to determine whether a medical provider breached the standard of care. If your child suffered a life-altering birth injury due to delayed or improper treatment of cervical insufficiency, seeking a legal consultation can help secure the financial resources needed for lifelong care and therapy.

Visit our free consultation page or video. Then contact the Kopec Law Firm at 800-604-0704 to speak directly with Attorney Mark Kopec. He is a top-rated Baltimore medical malpractice lawyer. The Kopec Law Firm is in Baltimore and pursues cases throughout Maryland and Washington, D.C.