Cervical Cerlage

About 25% of second trimester miscarriages are as a result of an incompetent cervix. During a normal pregnancy, the cervix remains closed until the estimated due date or around that time. Pressure from the baby growing puts pressure on the cervix. If the cervix is incompetent, it will begin to dilate. When the cervix begins to dilate and open, the baby begins to pass through the birth canal. The gradual thinning of the cervix occurs without contractions, so you are not aware that it is happening. Due to the weakening cervix, the amniotic fluid that surrounds your baby begins to leak into the cervical opening. Eventually, the membranes will break, causing either a miscarriage or premature birth.

Your doctor will know if you need this procedure if you have has a history of second trimester miscarriages, a previous damaged cervix( by D&C for abortion or miscarriage), or an abnormally chapped uterus or cervix. A pelvic exam or vaginal ultrasound will help diagnose an incompetent cervix and of course along with your medical history. The cervical cerlage is usually done in the third month of pregnancy, between weeks 12-14; however, it can be done at a later time. Once you have had this procedure performed, all future pregnancies will require a cervical cerlage.

During the procedure you will have general, spinal, or epidural anesthesia for pain. A doctor will stitch a tight band of strong thread around the cervix to hold the cervix firmly closed or a special tape can be placed around the cervix. This procedure is successful in 85% to 90% of cases. In order to be able to give birth, those stitches will need to come out. The sutures are typically removed between weeks 36 and 38. Although the initial procedure is done under some type of anesthetic, either local or general, removing the cerlage stitches can be done in your doctor’s office and should not be too painful.

After the procedure, you will be monitored for a few hours or overnight to assure no preterm labor. Plan to relax for 2-3 days after the procedure and avoid strenuous activity, follow instructions from the doctor on when to resume regular activities and sex.

Not all women will be able to be treated for incompetent cervix. Women who are affected by the following conditions will not be able to have a cervical cerlage.

  • Cervix is dilated 4cm or more
  • The fetus has died
  • Water has broken

This procedure cannot help all women who are having a difficult pregnancy. Is not used when a pregnant woman has vaginal bleeding or uterine contractions or if her membranes have ruptured early. If it is not meant to be then a miscarriage will happen with or without a stitch. Sometimes the baby will begin to pass through the vaginal canal and an emergency c0section will have to be performed. Cerlage has helped high-risk pregnancies last longer, but it also has risks-it can cause infection or miscarriage. For women who have had a preterm birth because the cervix did not stay closed, cervical cerlage may prevent another preterm birth.  Having a cervical cerlage can be life saving to your fetus.  

 

Reference

American Pregnancy Association. Cerivical Cerlage. (2006). Retrieved from: http://www.americanpregnancy.org/pregnancycomplications/cervicalcerclage.html

Shared Journey Your Path To Fertility. Incompetent Cervix. (2011) Retrieved from: http://www.sharedjourney.com/define/incomp.html

 

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