Tuesday, October 25

Second Trimester Miscarriages due to Cervical Incompetence

Closing the cervix by applying stitches ( Cerclage )

Cervical Incompetence is diagnosed when a woman is found to have a cervix that is opening, or she delivers the baby extremely prematurely without any associated contractions.
It is usually a second trimester disorder where the cervix which needs to remain close throughout the pregnancy, starts dilating and/or thinning.

Who is at the risk for this problem?
Primarily a woman who has had procedures on her cervix done before such as:
1) Cervix Conization (Biopsy of Cervix)
2) Leep Procedures (Removal of abnormal tissues from Cervix)
3) D & C procedure

This may disrupt the tissue of the cervix, so that it is unable to stay closed. Some women have Cervical Incompetence without any risk factors at all, especially women that have had this happened in their prior pregnancies or those who have history of pre term labor and weak cervix.
When a woman is at risk for cervical Incompetence, her doctor will take specific measures to try to find out, if this is the problem in the current pregnancy as well. Some of the ways this can be examined is by doing a transvaginal ultrasound or by manually checking the cervix, whether it is getting shortened or effaced.
Often, when you do an ultrasound in the second trimester, they are going to check the length of the cervix just to make sure that it’s still competent and closed.

Symptoms of Cervical Incompetence
These include subtle symptoms such as:
1) Feeling a lot of pressure
2) Feeling the need to push, as if the baby is coming out
Early in pregnancy, when the cervix first starts to open, there may not be any symptoms at all except for some changes such as spotting or discharge.

Treatment of Cervical Incompetence
Well, if the doctor(s) can catch this problem in early pregnancy before the cervix opens too much, then they may decide to do a procedure called “Cerclage”.
A Cerclage is where a doctor places a stitch in the cervix in order to hold it closed and strengthen it until the end of pregnancy. T when a doctor will remove the stitch so that a woman can deliver a baby.
Whether or not a Cerclage is appropriate for you will really depend on a lot of specific details about your case and needs to be discussed with your doctor.

In second trimester ultrasound scans , the sonographer must check for the length of cervix. If the cervix is found to be opened , the patient should be immediately sent for a more detailed physical examination of the cervix by the OB/GYN to determine any possibility of amniotic fluid getting pooled in the cervix area. Depending on your situation the doctor will prescribe for stitching the cervix. However if it is found that the membranes have come out of the cervix and reached till internal OS or external OS , the doctor might might advice strict bed rest and wait until you cross over to 28 weeks , or the doctor might decide to stitch only the outer part of the cervix.

Mere the opening of the cervix does not indicate that a miscarriage is imminent , neither it implies that Cerclage is the only solution. It also depends a lot on the progress of one's pregnancy , whether there is a balooning of the membranes . Cerclage can never be done if the cervix is too short ( < 0.5 cms ) or if the membranes have reached till the external OS of the cervix.

Dr Ranga

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