CERVICAL CERCLAGE

Treatment of cervical incompetence involves both conservative and surgical management. Cervical cerclage is the most common procedure performed when cervical incompetence is present and a portion of the cervical canal remains intact. Shirodkar and McDonald cerclage procedures are the most common.

ULTRASOUND

Ultrasound may be used to both assist the surgeon in placing the cerclage sutures (1,2) as well as evaluation of the efficiency of the cerclage.

• Sutures appear as a hyperechoic linear structure (± shadowing).
• Shadowing and echogenicity is most prominent in the region of the surgical knot (usually anteriorly placed).

• The anterior and posterior components (**) of the suture can be demonstrated on longitudinal and transverse images.

• It is essential to assess the relationship between the sutures to both the internal and external cervical os.
• It is important to determine whether a ling cervix has been established (3).
• Complications.
• Slipping suture.
• Protrusion of the membranes beyond the sutures.
• Further dilatation of the cervical canal.

These complications are important in determining the necessity for a second cerclage procedure (4).

REFERENCES

1. Wheelock JB, Johnson TR, Graham D et.al. Ultrasound-assisted cervical cerclage. J Clin Ultrasound 1984;12:307-308.
2. Fleischer AC, Lombardi S, Kepple DM. Guidance for cerclage using transrectal ultrasound. J Ultrasound Med 1989;8:589-590.
3. Parulekar SG, Kiwi R. Ultrasound evaluation of sutures following cervical cerclage for incompetent cervix. J Ultrasound Med 1982;1:223-228.
4. Rana J, Davis SE, Harrigan JT. Improving the outcome of cervical cerclage by sonographic follow up. J Ultrasound Med 1990;9:275-278.