The treatment consists of a strong suture sewn into and around the cervix early in the pregnancy, usually between weeks 12 to 14, and then removed towards the end of the pregnancy when the greatest risk of miscarriage has passed. The procedure is performed under local anaesthesia, usually by way of a spinal block. It is typically performed on an outpatient basis by an obstetrician-gynecologist. Usually the treatment is done in the first or second trimester of pregnancy, for a woman who has had one or more late miscarriages in the past. The word "cerclage" means "hoop" in French, as in the metal hoop encircling a barrel. There is no evidence that cerclage is effective in a multiple gestation pregnancy for preventing preterm births and reducing perinatal deaths or neonatal morbidity.