Cervical Cerclage

Regional · Spinal · 30–60 min

Indications

History-indicated (12-14 weeks)
Ultrasound-indicated (14-24 weeks)
Rescue with membranes at or through the os (up to 26-28 weeks)

Preparation

Aspiration prophylaxis from 18-20 weeks or if symptomatic: Omeprazole40mg PO
Left lateral tilt from 20 weeks

Aim for T10 - S4 block

NeuraxialSpinal

Prilocaine2% hyperbaric, 2.5 ml (50mg) + Fentanyl15mcg

Surgical block 60-90 minutes.

Positioning

PositionLithotomy(Left lateral tilt from 20 weeks)

Haemodynamics

PhenylephrineIf required
NIBP 2-3 min cycles until the block settles

Anti-emetics

Cyclizine50mg first line in first trimester
Ondansetron4mg

Analgesia

Paracetamol1g, QDS
Dihydrocodeine30mg, QDS PRN

Elective at 36-37 weeks, earlier for labour, ruptured membranes or infection
McDonald - often no anaesthetic, or Entonox in delivery suite
Shirodkar or a buried suture - spinal, same doses as insertion
Already labouring with a working epidural - top up and remove

Details

Author: Gas Cookbook
Updated: Oct 2026

For reference only. Always check doses against the BNF and your local protocols, and adapt to the patient in front of you. Gas Cookbook is community-shared guidance, not medical advice; clinical responsibility stays with you.

Pre-op

Block

Intra-op

Post-op

Cerclage Removal

Details

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