Monitoring competency of cervix following LEEP

QUESTION

Dear Ms Ultrasound,
I will be 9 weeks pregnant on June 30. I went to the OB office at 6 weeks pregnant and they performed a pelvic exam and blood tests, all of which were normal. I was surprised that they did not do an u/s then and expressed my concern about my cervix since I had a LEEP procedure (removal of pre-cancerous cells in cervix) done in 2000. The nurse practitioner looked at my cervix and told me that it should be fine. Before I was pregnant, my primary OB told me that he would need to watch me closely and take measurements regularly to monitor my cervix for competency. I have an appointment with him on July 15th (11 weeks, 1 day pregnant) to hear the heartbeat.

My questions are as follows:

  • When is it appropriate to perform a first u/s?
  • Can you tell the competency of a cervix by visual exam only?
  • What can I expect at my next appointment?

This is my first pregnancy and I am very excited! I had 2-3 dreams well before getting pregnant of having a baby boy. I could see his face so vividly in my dream! I guess I'll see what that means in February.

Thanks for your time!
Kim

ANSWER

Hi Kim,
You should have a baseline ultrasound to assess your cervix between 12 and 14 weeks. I like that your nurse told you that your cervix looked good. That is a good sign. Even though the cervix does not look compromised externally, this does not diagnose an incompetent cervix.

You are at a slight risk for an incompetent cervix because of the procedure you have had in your past. You will probably have a few ultrasounds to monitor the cervix and measure the length and width. If it begins to shorten and the doctor feels the cervix is incompetent there is a procedure done to suture closed the cervix. I wouldn't worry too much about that, since I don't think you are at high risk, from what you have shared with me.

At the next ultrasound they will have you come in with a full bladder which aids in visualization of the cervical area. The length and width of the cervix will be measured and the baby will also be looked at. Some facilities like to measure the cervix with a vaginal ultrasound probe. If that is the case they will have you empty your bladder for this procedure.

The best thing you've shared with me about your vivid dream is of seeing your baby boy's face. This should be the most comforting piece of information. A glimpse into your future showing you your child, is always a good sign for a positive outcome.

Let me know if you have a boy. I will include you in my stats.

-- Jane, RDMS

Jane Foley

Jane Foley has worked as a Sonographer (Ultrasound Technologist) since 1979. Jane has lived and worked in many parts of the world including Saudi Arabia. She is a Registered Diagnostic Medical Sonographer or RDMS. She pulls a wealth of information from her experience in the field of Radiology and her interactions with such a broad cross-section of cultures she has visited. She now makes her home on the island of Maui with her English husband, Michael.