Cerclage and complete closure of the cervical canal and external os (Fig and Video)
These are the exact instructions for performing a cerclage with complete closure of the cervical canal and external os (in case of a prolapsing amniotic sac), as carried out at the gynaecological clinic at the Fulda Clinic under Prof. Dr. Spätling. The study comparing the cerclage method with the cerclage method with total cervical os closure, published in ‘Gynäkologische Praxis’, was also conducted using the method described here.kompletter totaler Muttermunds-verschluss – Technik und Erfahrungen
This method was also used for patients with very early rupture of the membranes and a good pregnancy outcome.
A video can be seen on YouTube: https://www.youtube.com/watch?v=Kjqyb-_jBJo&t=78s
Placement of the cerclage tape
The cerclage tape is being applied. The anterior and posterior lip of the cervix is grasped with tissue forceps. A small swab is pushing the prolapsing amniotic sac cranially.
The cerclage tape is in place. It was knotted with a bar so that it can be pulled well later.
Attachment of the lateral holding sutures
Curettage of the cervical canal with the brush curette
Internal suture of the cervical canal with a small needle and absorbable thread
The cervical canal is now closed. The threads are then shortened as much as possible.
The superficial epithelium of the anterior and posterior lip of the cervix is removed with a scalpel.
Final closure of the cervix with continuous thread.
Post-operative: Vaginal ultrasound to rule out internal bleeding. Antibiotic prophylaxis for several days.