Incompetent cervix -- caring for it during pregnancy

Treatment Options

Once it's been diagnosed, a woman undergoes treatment for future pregnancies, which involves a surgical procedure called a cerclage. The cerclage is a purse-string stitch that acts as an cinch to keep the cervix from dilating. It's placed between 12-15 weeks gestation. The stitch is inserted surgically while the patient is under spinal, epidural, or general anesthesia. The procedure can be considered outpatient surgery, although there's a chance that you might need to spend the night in the hospital if you experience cramping or extensive bleeding.

Five types of cerclages

The McDonald stitch is the most common. It's the easiest to use and allows vaginal delivery. The stitch is woven in and out of the cervix and pulled tightly and tied to keep the cervix closed.

The Shirodkar stitch can be permanent (requiring a cesarean section) or be removed near term. The stitch starts at a 12 o'clock position, worked through the cervix to the 6 o'clock position, ending back in the 12 o'clock position on the other side of the cervix. It's pulled tightly and tied to keep the cervix closed.

An abdominal stitch is used when there is too little cervix to work with. The upper and lower part of the cervix are stitched together. A cesarean section is required for delivery.

The Hefner cerclage is commonly used when IC is diagnosed later in pregnancy. It has an added benefit when there is little cervix to work with. This cerclage is removed closer to term as well.

The Lash cerclage is the only type that's placed prior to pregnancy. This stitch is used in cases of extensive cervical trauma or an anatomical defect. It's permanent and requires a cesarean delivery.

What happens after the cerclage?

Once the cerclage has been placed, you'll be put on bedrest for a period of 24-72 hours. You could have your regular and sexual activity restricted or have bedrest continue if complications occur. Look for signs of increased discharge with odor, spotting, heavy bleeding, burning, itching or a fever over 101. If you notice any of these symptoms, contact your physician immediately.

Photo courtesy iStockphoto.

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!