Incompetent Cervix and Cerclage Procedures

What is an Incompetent Cervix? An incompetent cervix is one that opens prematurely under the stress of the growing uterus and occurs in about 2 percent of all pregnancies. It is believed that cervical incompetence is the cause of 20-25 % of all second trimester losses. Most miscarriages/preterm labors happen during weeks 16-24 of the pregnancy. Although, an overwhelming majority of the women on our message boards who reported having miscarriages due to an incompetant cervix, reported miscarrying at around 20 weeks gestation.

How is an Incompetent Cervix diagnosed? Unfortunately, most incompetant cervixes are only known about due to a prior miscarriage due to the same thing. However, your doctor may catch this if your cervix begins to open and thin prematurely, usually during the second trimester. A pregnant woman with an incompetant cervix may complain of contractions comparable in pain to prelabor contractions. Currently, transvaginal ultrasound is being used to measure the length of the cervix in an attempt to diagnose this condition sooner, so that a cerclage can be placed before a pregnancy loss.

Why doesn't everyone who has had a preterm birth get a cerclage? There are many causes of preterm birth. Cervical cerclages only help those women who have abnormal cervixes. Even with a cerclage, a preterm birth can occur or other problems can arise. A woman who has had a cerclage will be monitored more frequently throughout her pregnancy for symptoms of infection and premature labour.

Who is at risk for an Incompetant Cervix? Although the causes are unknown, you may be at risk for an incompetant cervix if you have had:

• D&C's (dilation & curettage) for abortion, miscarriage, or other reasons.
• Previous pregnancy loss in the second trimester.
• Surgery on your cervix.
• Multiple pregnancy terminations.
• Damage to the cervix from a previous birth.
• Are the daughter of a woman who took DES, a hormone used to prevent miscarriages.

• You have hyperirritability of the cervix.
• Your baby has already died.
• You are more than 4 cm dilated.
• Your water is broken.

• Complications could cause the need to undergo another cervical cerclage.
• It is possible that this operation will not help you.
• There is also a possibility that your current condition will worsen after surgery.
• As in any surgical procedure, bleeding and infection are potential complications of cervical cerclage for incompetent cervix.
• These complications can cause prolonged illness, the need for blood transfusions and even permanent disability.
• Although, perforation or puncture of the uterus is rare, this complication can cause pelvic bleeding and infection, and even bleeding and infection inside the belly.
• Very Rare: Rupture of the cervix, premature delivery or miscarriage or abortion, blood clots in the legs, pelvis, and lungs.
• Extremely rare: Allergic or other bad reactions to one or more of the substances used in the procedure.
• Some of the complications of this operation may require further surgery
• Some complications could potentially result in sterility or the inability to bear or have children.
• Very rarely, some of the complications can even be fatal.

  " I had severe contractions after surgery and lost my mucus plug. The surgery irritated my uterus, and I have had contractions ever since. I am on bedrest and oral meds around the clock. I am also on a home uterine monitoring system. The good news is that I have made it to 27 weeks! Though this pregnancy has been difficult, I finally feel like everything is going to be alright. My contractions have decreased signifigantly (from 9 to 3 every hour). I don't think that another pregnancy would be as difficult since the cerclage is already in place." ~susanmaried (4/22/02).

• Infrequently, fetal death, intrauterine growth retardation, suture migration, premature rupture of the membranes, placental abruption, and excessive blood loss.
• Rarely, a possible loss of your uterus.

"Unfortunately, I lost my baby on the operating table. The doctor did not know if it was the stress of surgery [abdominal cerclage] or a miscarriage that would have happened regardless. I now have the cerclage in place and am working with a fertility specialist to try and get pregnant again. Despite the enormous heartbreak of losing my first baby -- I truely believe that I have a very good chance at going to term with the abdominal cerclage in place." ~kzfuller (2/23/02).

 

• 12-24 hours after surgery, you will be on bedrest and monitored for possible preterm labor.
• Your doctor may recommend that you lie on your left side twice daily or may even restrict you to total bedrest.
• On some occasions, antibiotics will be given to prevent infection.
• Nothing is allowed inside vagina after the procedure (no douching either).
• You will asked to abstain from sexual intercourse (at least until 24-26 weeks).
• Because breast stimulation causes contractions, you will be asked to abstain.
• You may have to abstain from strenuous activity including heavy lifting.
• You may be scheduled for a follow-up visit in 1 week.
• Your physical activity may be restricted, including heavy housework and frequent stairs.
• You may have more frequent prental visits - possibly every 1-3 weeks to have your cervix checked.

  Of transabdominal cerclage while pregnant: "The surgery is painful--I had morphine for 48 hours and could not sit up, or walk, unaided for 4 days. Far worse than a cesarian section. I had to take indomehtacin until week 23 as I kept on contracting. But it worked, and the suture is still there so if we want another baby I won't need the surgery again." ~Jane Laura Smith (2/24/02).

  Of transabdominal cerclage: "My operation went without incident, it was only as painful as a C section for me and I was up and around in 2 or 3 days." ~Lynne (11/26/02).

  Of vaginal cerclage: "When I have the cerclage put in, I have to be on strict bedrest like I am now. This is my third child...There are a lot of downfalls like bedrest and lots of weight gain, it even hurts bad when the stitch gets pulled out and you can feel the scab aroud it. With my second, I got a mild yeast infection because a piece of stitching was lost in my cervix. But... when I look at my kids and feel this one moving, it is definately worth the trouble." ~nappere1osuedu (12/27/02).

  Of transabdominal cerclage before pregnancy: "My Dr. told me that because I was fit I would be feeling back to normal within 2 weeks and he was right. I was even back to work within 2 weeks after the surgery." ~Kara (12/31/02).

  Of the vaginal cerclage: "My experience with the vaginal cerclage was not painful at all. They put me under and then did the procedure." ~Sandra (1/16/03).

  Of the vaginal cerclage: "I had a spinal and didn't feel anything but pressure but that didn't bother me either. I could tell each time she did the stitch and when she tightend it in the end. But I didn't actually "feel" it. I could see my body move. I did have some pain after everything wore off and I was on my way home from the hospital. But once I urinated the pain went away. I guess it was because of the pressure. I am now a week later and I feel great. It doesn't feel like I even have a stitch in." ~Karen (12/13/00).

• Symptoms of Preterm Labor
  • Cramping
  • Lower back pain
  • Contractions of tightenings
  • Pressure in lower back, abdomen, or thighs
  • Increase or change in vaginal discharge
• Leaking of fluids or breaking of bag of waters.
• A temperature above 100 F (38 C) degrees.
• Vaginal bleeding or spotting
• Chills.
• Nausea and vomiting.
• A bad-smelling vaginal discharge.

"I just had my cerclage removed last week and am awaiting the arrival of my daughter. I felt every little pressure ten times worse, but my doctor said that this was normal." ~ncabeen (3/27/01).