Shirodkar Cerclage Procedure
Definition
- SHIRODKAR (Cerclage for Incompetent OS)
- The placement of an encircling “tape” ligature at the level of the internal cervical os to maintain the integrity of the cervical canal.
Discussion
- The procedure is usually performed to prevent premature dilation and subsequent spontaneous expulsion of the fetus prior to safe delivery.
- It is usually recommended for patients who have a history of spontaneous abortion in the first trimester of pregnancy.
- Incompetency may be related to previous lacerations or a congenital weakness.
- The procedure has the best result when perfomed before the cervix actually dilates.
Positioning
- Lithotomy; arms may be extended on armboards.
Packs/ Drapes
- Gynecologic pack
Instrumentation
- D&C tray
- Cervical biopsy tray
- Short honey retractors
- Ligature carrier
Supplies/Equipment
- Stirrups
- Suction
- Tape ligature
- Perineal pad
- Solutions
Procedure
- The cervix is excised using a transverse incision in the vaginal mucosa, at the anterior aspect of the cervix.
- The bladder is retracted away.
- A similar incision is made posteriorly.
- The synthetic tape ligature is placed around the internal os.
- The tape is tightened and secured.
- The posterior portion of the tape loop may be sutured to the vaginal mucosa, and the cervix is closed.
Perioperative Nursing Considerations
- Stirrups should be padded, and a coccygeal support placed on the table to protect the lower sacral area.
- Raise and lower the legs together slowly to prevent alteration in venous return.
- Instruments are set up on the back table in order of usage.
