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

1. The cervix is excised using a transverse incision in the vaginal mucosa, at the anterior aspect of the cervix.
2. The bladder is retracted away.
3. A similar incision is made posteriorly.
4. The synthetic tape ligature is placed around the internal os.
5. The tape is tightened and secured.
6. The posterior portion of the tape loop may be sutured to the vaginal mucosa, and the cervix is closed.

Perioperative Nursing Considerations

1. Stirrups should be padded, and a coccygeal support placed on the table to protect the lower sacral area.
2. Raise and lower the legs together slowly to prevent alteration in venous return.
3. Instruments are set up on the back table in order of usage.