Admin
August 20, 2026
During pregnancy, the cervix normally stays closed and supports the growing baby inside the uterus. In some women, however, the cervix can become shorter or start opening too early. This can increase the risk of pregnancy loss in the second trimester or premature birth.
When the cervix has already started opening during pregnancy, doctors may consider a procedure called emergency or rescue cerclage. A cerclage is a stitch placed around the cervix to provide additional support and help keep it closed.
Cerclage is not the same for every patient. Depending on the pregnancy history, cervical condition and previous treatment, a doctor may recommend a rescue Shirodkar cerclage, vaginal cerclage, abdominal cerclage or laparoscopic abdominal cerclage.
At Amayra Healthcare, Chandigarh, Dr. Ajay Aggarwal provides specialist evaluation and surgical management for complex cerclage cases, including rescue Shirodkar cerclage and abdominal/laparoscopic cerclage.
Cervical cerclage is a procedure in which a strong stitch is placed around the cervix to help support it during pregnancy.
The cervix is the lower part of the uterus that opens into the vagina. Normally, it remains closed during most of pregnancy and opens when labour begins.
If the cervix begins shortening or opening too early, there may be an increased risk of late miscarriage or premature birth. In carefully selected women, a cervical stitch may help provide support and prolong the pregnancy.
There are different types of cerclage, and the best option depends on the individual patient.
An emergency cerclage, also called a rescue cerclage, is performed when the cervix has already started opening during pregnancy.
Unlike a planned cerclage, which may be performed because a woman has a known risk of cervical insufficiency or a history of pregnancy loss or premature birth, rescue cerclage is considered after a problem with the cervix has already developed.
In some cases, the cervix may be significantly open and the fetal membranes may be visible through the cervical opening. If there are no signs that would make the procedure unsafe, a specialist may consider rescue cerclage as an attempt to prolong the pregnancy.
It is important to understand that rescue cerclage is not suitable for every pregnancy. The doctor must carefully assess the cervix, membranes, pregnancy, and overall health before recommending the procedure.
There can be several reasons why the cervix becomes shorter or opens before the baby is ready to be born.
Some women may have:
A previous second-trimester pregnancy loss
A previous spontaneous preterm birth
A previous cervical cerclage
Previous surgery or procedures involving the cervix
An abnormality of the uterus or cervix
A history suggesting cervical insufficiency
Progressive shortening or opening of the cervix during pregnancy
Sometimes, there may be no obvious single cause.
It is also important to remember that cervical insufficiency is more complicated than simply having a "weak cervix." Cervical changes can be influenced by several factors during pregnancy.
Rescue cerclage may be considered when the cervix has already opened during pregnancy, particularly in the second trimester, and the pregnancy is otherwise considered suitable for attempting the procedure.
Before recommending a rescue cerclage, the doctor will usually assess:
How much the cervix has opened
The condition of the fetal membranes
Whether there are contractions
Whether the waters have broken
Whether there are signs of infection
The stage of pregnancy
The condition of the mother and baby
A cervical stitch is generally not advised when there are circumstances such as infection, significant bleeding, established contractions or ruptured membranes, although management is always individualised.
Because the situation can change quickly, women who are told that their cervix is opening early should seek specialist obstetric assessment promptly.
Shirodkar cerclage is a type of vaginal cervical cerclage in which the stitch is placed relatively high around the cervix.
It may be considered in selected patients when a higher cervical stitch is appropriate. A rescue Shirodkar cerclage can be technically more challenging when the cervix has already opened significantly.
The doctor has to consider the amount of cervical dilatation, the position of the membranes and the overall condition of the pregnancy before deciding whether the procedure is appropriate.
At Amayra Healthcare, Dr. Ajay Aggarwal performs rescue Shirodkar cerclage in selected cases after detailed assessment.
Patients often ask about the difference between a planned cerclage and a rescue cerclage.
A planned cerclage may be recommended early in pregnancy when a woman has a significant history suggesting an increased risk of cervical insufficiency or second-trimester pregnancy loss.
In some pregnancies, the cervix is monitored using ultrasound. If significant shortening is detected, the doctor may discuss whether a cervical stitch or another treatment is appropriate.
Rescue cerclage is considered when the cervix has already opened during pregnancy.
The important point is that the right type of cerclage depends on the patient's individual circumstances. A short cervix does not automatically mean that every woman needs the same treatment.
For some women, a vaginal cerclage may not be suitable.
An abdominal cerclage, also called transabdominal cerclage (TAC), places the stitch around the cervix through the abdomen rather than through the vagina.
It may be considered for women who have had a previous vaginal cerclage that did not prevent a very early spontaneous birth, or when a vaginal cerclage cannot technically be placed.
Abdominal cerclage is generally planned before pregnancy or during early pregnancy in suitable patients. It is different from an emergency vaginal rescue cerclage.
A laparoscopic abdominal cerclage is a minimally invasive way of placing an abdominal cerclage.
Instead of making a larger abdominal incision, the surgeon uses small incisions and a camera along with specialised surgical instruments.
The choice between laparoscopic and open abdominal cerclage depends on several factors, including:
Gestational age
Previous abdominal or pelvic surgery
Anatomy
Technical feasibility
Available surgical expertise
Current SMFM guidance considers both laparoscopic and open approaches acceptable in appropriately selected patients.
An abdominal cerclage usually remains in place, so delivery is generally by caesarean section.
This is an important question because rescue Shirodkar cerclage and abdominal cerclage are not the same procedure.
When a woman presents with an already open cervix during pregnancy, the immediate treatment decision depends on her gestational age, cervical findings, membrane condition, presence of infection or contractions, and other factors.
Abdominal cerclage is generally used for specific indications and is often planned before pregnancy or in early pregnancy. In selected women who present later in pregnancy with an indication for abdominal cerclage, it may still be considered before a certain gestational age, depending on specialist assessment.
Therefore, it is important not to assume that one type of cerclage is suitable for everyone.
Before performing a rescue cerclage, the doctor will carefully evaluate the pregnancy.
This may involve:
Reviewing your previous pregnancy history
Examining the cervix
Performing an ultrasound when appropriate
Assessing whether the membranes are intact
Checking for contractions
Looking for signs of infection
Assessing the overall condition of the pregnancy
The purpose of this assessment is to determine whether rescue cerclage is likely to be appropriate and whether the potential benefits outweigh the risks.
The exact procedure depends on the type of cerclage being performed.
For a vaginal cerclage such as a Shirodkar cerclage, the stitch is placed around the cervix through the vaginal route.
In a rescue procedure, the cervix may already be open, which can make the procedure more technically challenging.
The surgical team takes precautions to minimise pressure on the membranes and carefully places the stitch in an appropriate position.
Because every case is different, the exact surgical technique and anaesthesia plan are discussed with the patient before the procedure.
Like any surgical procedure, cerclage has possible risks.
These may include:
Bleeding
Infection
Injury to the cervix
Injury to nearby structures such as the bladder
Premature rupture of membranes
Uterine contractions
Difficulty placing the stitch
Pregnancy loss or premature birth despite the procedure
Rescue cerclage can have greater risks than a planned cerclage because the cervix may already be open and the membranes may be exposed. RCOG notes that an emergency stitch has higher risks and does not always work.
Your doctor should explain the potential benefits and risks before you make a decision.
After cerclage, your pregnancy will require appropriate follow-up.
Your doctor may recommend regular antenatal appointments and monitoring based on your individual circumstances.
You should contact your healthcare team promptly if you experience symptoms such as:
Vaginal bleeding
Fluid leakage
Regular contractions
Significant abdominal or pelvic pain
Fever or feeling unwell
A cerclage can provide cervical support, but it cannot guarantee that premature birth or pregnancy loss will not occur.
Abdominal cerclage may be considered in selected women, particularly those with a history of a failed vaginal cerclage or situations where a vaginal cerclage cannot be placed.
According to SMFM recommendations, transabdominal cerclage should be offered to patients with a previous transvaginal cerclage and a subsequent spontaneous singleton delivery before 28 weeks. The approach may be laparoscopic or open depending on the individual situation and surgical expertise.
Directly from our patients about their experiences with Amayra Health Care.
