Incompetent cervix -- caring for it during pregnancy

by Tristine Miller and Julie Snyder

Tristine recalls her experience with IC

Incompetent CervixWhat causes an incompetent cervix? How is it treated? Are there risks to a cerclage?

A week before we lost our son, I had gone into the doctor's office for our 19-week ultrasound. We were anticipating finding out if we were having a boy or girl. We were also excited to see real baby features aside from the blobs we had seen at earlier ultrasounds. We left the office full of pride and excitement.

A couple days later, I felt something different. I knew the baby's movements were going to be felt soon. In fact, I thought I had felt a little twinge of a foot or an arm before our ultrasound. I had never carried a pregnancy this far before so wasn't sure what I was feeling. It felt as if the baby had moved somehow, the weight of the baby causing more pressure on my intestines and bladder. Since it did not seem painful or accompanied by other symptoms, I wrote it off as the baby just doing battle with my insides.

Tragedy hit us three days later. I started feeling as if I was constipated. I woke up early Monday morning with pain, but it wasn't regular or unbearable. I drank some prune juice and went back to bed. I woke up an hour later to more pain. I kept feeling like I had to go to the bathroom but nothing would happen. Finally, I realized something wasn't right and I woke my husband to take me to the emergency room.

I felt that sensation of having to go to the bathroom again. On my way from the bedroom to the bathroom, I felt this huge gush of fluid. Panic set in. My water broke. I screamed for my husband to hurry and get dressed. He helped me lay down on the couch while he gathered his thoughts. I felt down between my legs and could feel something protruding from my vagina. Was it the sac? Was it my son's head? The pain became more intense. I knew I could not sit up in the car so we called for an ambulance.

The paramedics arrived and put me on a stretcher. I heard them mention placenta previa. They thought they were looking at the bag of waters. I could feel my body push. The paramedic told me not to push if I could help it. I tried to stop my body from pushing but had was no control. My son was born one minute before we reached the hospital. It was one week since our ultrasound and the day before my 23rd birthday. Gabriel passed an hour later.

Since the loss of our son, I have been diagnosed with IC. I know this means we'll face more challenges to starting our family. Once I make it to 12 weeks, my doctor plans on giving me a cerclage. I am hopeful that this will help us carry to term. While it may include risks and changes in lifestyle, all I can focus on is how much it will be worth enduring if I can come home from the hospital with my next baby in my arms.

What causes an incompetent cervix?

An IC accounts for 20-25 percent of all second trimester losses. Many women aren't aware they have one until after they've experienced two or more losses in the second trimester.

The causes can range from trauma to the cervix including extensive cervical conization (cervical biopsy), uterine abnormalities and anomalies, exposure to the drug DES. Even previous childbirth can weaken the cervix. For some women, there's no definitive cause.

Diagnosing an incompetent cervix

It can be diagnosed via manual examination. Vaginal ultrasounds can help monitor the cervical length and check to see if the cervix is opening. When the cervical opening is greater than 2.5 cm, or the cervical length has shortened to less than 20mm, a diagnosis can be made for IC. Also, funneling of the cervix can be a sign that the cervix has begun to efface. You might experience increased discharge and feeling heaviness in the pelvis. This can be caused by a dilated cervix feeling the pressure of the bag of waters. When the cervix is dilated, there is no pain until the membrane rupture and labor is triggered, or the bag of water moves far into the birth canal in effect, bulging from the cervix. Tragically, many cases are not detected until premature delivery occurs.

Comments

On 10-9-10 i lost my son who was born at 20 weeks and a day.. the doctors had no idea why it happened.. i found out i was pregnant with my second baby a few days before christmas of 2011.. on april 3 2012 i went for my 19 week sonogram at the specialist to find out the sex of the baby.. she was a girl.. but at the appointment the specialist found that my cervix was shortening,. i knew nothing about the situation.. a cervical cerclage was discussed a little but the specialist said it was too risky.. so instead i was put on pegesterone to help the situation.. on april 9th i went into labor at 19 weeks and 6 days.. on april 10th my baby girl was born and died.. the doctors dont understand why an emergency cervical cerclage was not done.. im so worried about being able to have kids now... but the more i look at it.. the more the cervical cerclage looks like an option that could work.. but i am so scared that it wont work for me

Hi and welcome to Pregnancy.org! I'm sorry that you are concerned about having a potential 2nd trimester miscarriage due to an incompetent cervix. Having gone through several losses myself, some later -- I know that it can be a scary time for you. Unfortunately, many times there are no external symptoms of IC until the point where your membranes rupture (i.e. water breaks.) You *may* feel pressure/heaviness in your pelvic region but that can be difficult to distinguish from simply feeling heavy with the adjustments of your pregnancy progressing. Our "Incompetent Cervix: An Overview" article can provide you with more details regarding possible causes, diagnosis, and treatment options available if caught early enough.

If you are currently pregnant and are concerned about a possible IC, talk with your medical care provider. Requesting an ultrasound or pelvic exam to look specifically at cervical opening or cervical length will give the best capability of diagnosis. Do take heart that only 1 - 2 % of all pregnancies will have an IC.

If you have experienced a recent loss, please accept my sincere condolences.

Either way, I do hope that you are able to get answers. Please join in our Community forums for even more support throughout your journey. If I can be of any further assistance, feel free to drop me a note anytime! Please respond again and let us know how you are!

~MissyJ (missyj@pregnancy.org)

Hi all,I'm new to the site. I just wanted to know the symptoms of a second trimester miscarriage due to IC.

Thank you for posting your experience online. It really helped me to gain confidence a little.

I had a miscarriage at 15 wks last march. I am 10 wks pregnant again with God's grace now. My doctor has suggested me having cerclage done this time to be safe. As they were not able to diagnose the actual cause of the loss.

I was a little worried about the whole procedure. But, I did get a little confidence reading this article and experience. Hopefully everything works out well this time.

Many of these blogs are very comforting. I found I had an incompetent cervix after losing one baby at almost 16 wks gestation,and pregnant with my now 10 year old daughter. Around 15 wks, while pregnant with my daughter, the doctor noticed that my cervix was dilated. I asked in a fearful manner, "how dilated?" And he calmly replied all the way dilated. I was rushed in for emergency cerclage placement to the hospital next door. And because I had very little understanding of the severity of situation, I walked to the hospital next door and left my car in the parking lot. It was a beautiful sunny afternoon. I thought the walk would be good.

But things worked out just fine. The cerclage was placed successfully, and while I didn't carry my daughter to term, we did make it to around 32 wks. She premature, but otherwise healthy and just fine. No complications with her birth. She had to gain a little over a pound before we could bring her home, but it was worth the wait.

Now my husband and I are trying for another child, and my doctor and I have already discussed the placement of another cerclage at 13wks. It really is scary knowing that the cervix even with a cerclage may not hold the baby. But I am willing to try. I envy those women who can get pregnant, jog, maintain stressful jobs and leave work at 5 pm to go deliver a healthy baby by 10pm. I could only dream.

Love and support for all the mothers to be that have or will be diagnosed with IC. I went through 7 miscarriages due to this before I was even diagnosed. Previously it was said to be caused by endometriosis or scaring in the uterus. After I was diagnosed with IC I completed my first pregnancy. My son is now 5 years old and already in kindergarten. I am also pregnant again and have already had my cervix stitched. I am a little past 18 weeks and have had no signs of problems.

We just found out we are having another boy. My son is very excited to become a big brother. I also have a twin sister with the same problem. She was diagnosed after her third miscarriage. She now has three beautiful children -- two boys and a girl.

I hope this article gives hope to any women dealing with Incompetent Cervix that they can not only have a child but have several children if they wish. There may be some problems on the way -- maybe even a few disasters. But if it's something you truly want, you can get there. Good luck to all of you!