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

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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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