What Is An Incompetent Cervix?
A weakened cervix, a condition which happens in about one in 100 pregnancies, occurs when the weight of the growing baby creates enough pressure to cause the cervix to open before the baby is ready to be born. An incompetent cervix may result in miscarriage or a premature delivery.
There a several possible causes for a weakened or incompetent cervix, among them, previous surgery on the cervix or damage to the cervix during a difficult birth or miscarriage. If the cervix or uterus is malformed due to a birth defect, this can also create a weakened cervix. Since it is not something routinely checked for during a pregnancy, it may not be diagnosed until after a miscarriage in either the second or third trimester has occurred. If there is suspicion of a weakened cervix, the doctor will be alert to it and an ultrasound may be used to diagnose it.
Why Is Cervical Cerclage Used?
In order to address this situation and prevent a preterm delivery, a woman's doctor may recommend she have a cervical cerclage. This procedure is used to prevent early changes in the cervix which would cause the cervix to open and the pregnancy to be lost. By closing the cervix with a cerclage, the developing baby is kept inside the uterus until the pregnancy is 37-38 weeks along.
The cerclage is best performed in the third month of pregnancy. Some women may require a cerclage later in their pregnancy and this is called an emergent cerclage. It is necessary if changes to the uterus have begun, such as a shortening or opening of the cervix later in the pregnancy. If a woman has had an emergent cerclage than often it is necessary to perform the same procedure in all future pregnancies.
How A Cervical Cerclage Is Performed
A cervical cerclage is performed on women with an incompetent or weakened cervix and is not a general procedure to prevent preterm labor or birth. Done under anesthesia for pain control, the doctor will stitch a strong thread around the cervix to hold it tightly closed. The woman will be monitored for premature contractions or labor and provided all is well, she will go home within a few hours of the procedure. There may be some light bleeding and cramping following the cerclage, but that should go away in a few days. Medication may be prescribed to prevent infection or preterm labor and a few days of rest will be recommended.
The cerclage stitch is most often removed at the 37th week of pregnancy. However, if the woman's water breaks or if contractions start, then the stitch will be removed earlier if necessary. Most frequently the stitch is removed in the doctor's office without any difficulty.
The Value Of Cervical Cerclage
The risks of cerclarge are outweighed by the fact that most doctors consider it to be a life saving procedure. Possible risks include premature contraction, the inability of the cervix to dilate naturally during labor, rupture of the membranes, infection, a tear in the cervix if labor precedes removal of the stitch and the general risks of anesthesia.
Most women who need a cerclage with one pregnancy will likely need one with following pregnancies.