Cervical Suture Removal - SESLHD Home Page
ROYAL HOSPITAL FOR WOMEN
LOCAL OPERATING PROCEDURE
CLINICAL POLICIES, PROCEDURES & GUIDELINES
Approved by Quality & Patient Safety Committee
20/6/13
CERVICAL SUTURE / CERCLAGE ¨C REMOVAL GUIDELINE
1. OPTIMAL OUTCOMES
? Removal of suture using an aseptic technique prior to established labour
2. PATIENT
? Woman with Shirodkar or McDonald suture
3. STAFF
? Medical Staff
? Registered midwife
4. EQUIPMENT
? Speculum
? Long handled scissors
? Rampley¡¯s forceps
? Spotlight
5. CLINICAL PRACTICE
? Remove suture electively between 37 and 38 weeks gestation. With woman in lithotomy
position:
o insert duck-billed speculum
o identify knot
o grasp with Rampley¡¯s forceps
o cut suture next to cervix
o ensure entirety is removed
? Remove suture in an emergency in the event of pre-term labour or membrane rupture to avoid
infection
6. HAZARDS/SUB-OPTIMAL OUTCOMES
? Infection of the cervix
? Chorioamnionitis
? Injury to the cervix or bladder
? Bleeding
7. DOCUMENTATION
? Integrated clinical notes
? Yellow card
8. EDUCATIONAL NOTES
? Decision making with regard to insertion of a cervical suture is complex and controversial and
made on a case by case basis
? If a woman labours with her suture in, it may cause a severe cervical tear, cervical
1
incompetence or rupture of her uterus .
? When McDonald cerclage is electively removed at 36-37 weeks only a small number of
women (11%) spontaneously deliver within 48 hours, and mean interval from removal to
2
spontaneous delivery is 14 days .
¡/2
2.
ROYAL HOSPITAL FOR WOMEN
LOCAL OPERATING PROCEDURE
CLINICAL POLICIES, PROCEDURES & GUIDELINES
Approved by Quality & Patient Safety Committee
20/6/13
CERVICAL SUTURE / CERCLAGE ¨C REMOVAL GUIDELINE
9. RELATED POLICIES/PROCEDURES/CLINICAL PRACTICE GUIDELINES
? Cervical shortening
? Obesity in pregnancy, labour and postpartum
? Aseptic Technique
10. REFERENCES
nd
? Williams Obstetrics 22 edition 2005, Chapter 9. McGraw-Hill, New York.
? Bisulli M, Suhag A, Arvan R, et al. Interval to spontaneous delivery after elective removal of
cerclage. American Journal of Obstetrics and Gynaecology 2009 Aug: 201: 163.e 1-4.
REVISION & APPROVAL HISTORY
Reviewed June 2013
Approved Quality & Patient Safety Committee 15/10/09
Endorsed Obstetrics Clinical Guidelines Group September 2009
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