Cervical cerclage

Summary

A cervical cerclage is a stitch placed around the cervix (the neck of the womb) during pregnancy to help keep it closed, reducing the risk of late miscarriage or very early birth in women whose cervix tends to open too soon. It is placed through the vagina, with no cuts on the abdomen.

• Usually placed between 12 and 14 weeks of pregnancy, or later if a scan shows the cervix shortening.
• Done under spinal anaesthesia in most cases; you are usually home the same day or the next morning.
• The stitch is removed in a simple clinic or ward procedure at around 36–37 weeks, so labour can happen normally.
• The pregnancy continues normally with the stitch in place — most women need only routine care alongside it.
• If the cervix is too short or scarred for a vaginal stitch, a keyhole abdominal stitch is an alternative — see our laparoscopic cervical cerclage guide.

This information supports discussion with your healthcare team. Reading, saving or printing it does not constitute consent to surgery.

About the operation

The cervix normally stays firm and closed until labour. In some women it shortens and opens silently in mid-pregnancy — this is called cervical weakness or cervical insufficiency, and it can lead to late miscarriage or birth long before the baby is ready. A cerclage supports the cervix mechanically: a strong tape or thread is placed around it like a purse-string and tied, holding it closed.

Depending on when and why it is placed, a cerclage is described as:

• History-indicated — planned from early pregnancy (usually 12–14 weeks) because of previous late losses or very early births.
• Ultrasound-indicated — placed later (usually before 24 weeks) when serial scans show the cervix shortening.
• Emergency (rescue) cerclage — placed when the cervix has already begun to open; a more difficult situation, discussed case by case.

The common vaginal technique (McDonald) needs no cuts at all; the stitch sits high on the cervix and its ends are left where they can be found easily for removal.

Why it is performed

• Previous late miscarriage(s) (after 14 weeks) or very early births where cervical weakness is the likely cause
• A short cervix on scan in this pregnancy, especially with a history of early birth
• Previous surgery to the cervix — such as cone biopsy or repeated LLETZ — that has weakened it

Not every woman at risk needs a stitch: for some, vaginal progesterone or simple scan surveillance of the cervix is the better plan. Your history and scans decide this together with you.

Benefits

• A lower chance of late miscarriage and very early birth in women whose risk comes from cervical weakness — the further a pregnancy is carried, the safer for the baby.
• A simple, short procedure with no abdominal cuts and usually same-day discharge.
• Normal labour remains possible — the stitch is removed at around 36–37 weeks and birth can then proceed normally.

Alternatives

• Scan surveillance — regular measurement of the cervix, placing a stitch only if it shortens.
• Vaginal progesterone — reduces the risk of early birth in women with a short cervix, and is the preferred option in some situations.
• Laparoscopic (abdominal) cerclage — a permanent stitch placed by keyhole surgery at the very top of the cervix, for women in whom a vaginal stitch has failed or is not technically possible — see our guide.

Preparing for surgery

Before a planned cerclage you will have an ultrasound scan to confirm the pregnancy is progressing normally and to assess the cervix. Swabs or urine tests may be taken so any infection can be treated first. You will have a review of your medicines and general health; tell the team about all medicines you take and any previous surgery or anaesthetic problems.

• Fasting: exact instructions are given; typically no food from 6 hours before, water up to 2 hours before.
• At home: arrange for someone to take you home and plan a quiet day or two afterwards.

The day of surgery

You are usually admitted on the day of the procedure. The team confirms your identity and the plan, and you meet the anaesthetist and the surgeon — this is the time for last questions.

You will be asked to sign the consent form, which records the procedure, its intended benefits and its risks as they apply to you. You can still change your mind at this point.

During the operation

The stitch is usually placed under spinal anaesthesia — you are awake but numb from the waist down and feel no pain; a general anaesthetic is used in some cases. With your legs supported, the surgeon works entirely through the vagina: the cervix is gently steadied, and a strong tape or thread is passed around it in a purse-string and tied firmly, keeping the cervix closed while leaving the ends accessible for later removal.

The procedure itself commonly takes 15–30 minutes. The baby is checked before and after.

After the operation

• Cramping and spotting for a day or two is common and settles; simple pregnancy-safe painkillers (paracetamol) are enough for most women.
• Going home: usually the same day or the next morning, once you have passed urine normally after the spinal.
• Discharge: a change in vaginal discharge is common with a stitch in place throughout pregnancy.

Recovery at home

• First few days: take it easy; avoid heavy lifting and strenuous exercise while cramping settles.
• Normal life: most women return to usual activity within a few days. Prolonged strict bed rest is not recommended.
• Sex: ask your own team what is advised in your case.
• The rest of pregnancy: antenatal care continues normally, sometimes with extra scans of the cervix.
• Removal: the stitch is removed at around 36–37 weeks — usually a quick clinic or ward procedure without anaesthetic — or immediately if labour starts earlier. If a caesarean is planned, it can be removed at the caesarean.

These are typical arrangements; your own advice may differ and comes first.

Risks and complications

Cerclage is a safe procedure in experienced hands, and serious complications are uncommon. The risks below are discussed with you and weighed against the risk of doing nothing — which, for the women who need a stitch, is the greater risk.

Expected, temporary effects

• Cramping, spotting and a change in discharge for a few days

Complications

• Rupture of the membranes around the baby during or after placement — the most important risk, higher for emergency stitches placed when the cervix is already open (uncommon for planned stitches).
• Infection of the membranes or the vagina (uncommon).
• Bleeding — usually minor (uncommon).
• Miscarriage or early labour despite the stitch — a cerclage reduces risk; it cannot remove it.
• Cervical tearing if labour begins strongly with the stitch still in place — the reason to come in without delay if contractions start (rare).
• Stitch displacement — occasionally the stitch slips and needs replacing (uncommon).
• Bladder injury or damage to the cervix at placement (rare).
• Anaesthetic risks — serious complications of spinal anaesthesia are rare.

When to seek help

With a cerclage in place, come to the hospital without delay — at any hour — if you notice:

• Contractions, regular tightenings or period-like pains
• A gush or steady trickle of fluid — possible breaking of the waters
• Vaginal bleeding
• Fever (38 °C or higher), feeling unwell, or an offensive-smelling discharge
• Reduced movements of the baby (after the age when you feel them regularly)

Preparing for your consent discussion

Consent is a conversation, not a signature. Before agreeing you should feel you understand why a stitch is recommended for you, what the alternatives are, and which risks matter most in your case. The checklist below is a starting point — print it and bring it to your consultation.

Sources and review

This page was drafted against the published guidance below. Each reference was live when checked; dates will be confirmed at clinical review.

1. Royal College of Obstetricians and Gynaecologists. Cervical cerclage. Green-top guideline. London: RCOG. Available from: https://www.rcog.org.uk/guidance/browse-all-guidance/green-top-guidelines/ [last checked 9 August 2026].
2. National Institute for Health and Care Excellence. Preterm labour and birth. NICE guideline NG25. Available from: https://www.nice.org.uk/guidance/ng25 [last checked 9 August 2026].
3. Royal College of Obstetricians and Gynaecologists. Patient information — cervical stitch. Available from: https://www.rcog.org.uk/for-the-public/browse-our-patient-information/ [last checked 9 August 2026].