What Is Shirodkar Suture?

It is a non-absorbable stitch that is inserted and put around the cervix (the neck of the womb or uterus) to hold it closed in order to reduce the risk of a miscarriage or premature birth.

Why is it done?

You have a weakness in your cervix and multiple pregnancy. This is called cervical incompetence. At the end of a normal pregnancy the cervix dilates, which means it opens to allow the baby to enter the birth canal to be born. With cervical incompetence, your cervix may open before your baby is full term. This increases your risk of miscarrying, especially between weeks 16-26 of pregnancy. Later in pregnancy a weak cervix can cause premature birth.

When there is a history of late spontaneous miscarriage/s that suggest you have cervical incompetence (i.e. a weak cervix), the insertion of a cervical suture may help to reduce the risk of a miscarriage or premature birth.

What to expect after surgery?

Post-operatively you will be on bed rest for the next 24 hours, possibly in the Trendelenburg position. And monitored for uterine activity.

Once released from the hospital you will be on pelvic rest (no sex) for the remainder of the pregnancy. You will need to have periods of rest each day and decreased physical activity. You will also be monitored for preterm labor. If you have any contractions you should contact the doctor right away.

What are the risks of the surgery?

While these procedures are life-saving, they also have potential risks:

• Premature rupture of membranes (1-9%)
• Chorioamnionitis (Infection of the amniotic sac, 1-7%) (This risk increases as the pregnancy progresses and is at 30% for a cervix that is dilated more than 3 cms.)
• Preterm Labor
• Cervical laceration or amputation (This can be at the procedure or at the delivery, from scar tissue that forms on the cervix.)
• Bladder Injury (rare)
• Maternal hemorrhage
• Cervical dystocia
• Uterine rupture

What are the alternatives to the surgery?

If the Shirodkar or MacDonald suture should fail it may be possible to place a different suture around your cervix from inside your abdomen. This is called an abdominal cervical suture. It is a bigger operation with more risks. This would mean making a cut in your lower abdomen to place the suture around your cervix.