Complications & Cesareans – Incompetent Cervix

Carol Alvarado of Browns Valley, Calif., is the very happy mother of two healthy children – but she endured a great deal of difficulty to reach this point. While pregnant with her first child, at the age of 29, Carol was diagnosed with incompetent cervix.

Incompetent cervix is a condition in which a pregnant woman’s cervix is softer and weaker than normal, and as a result, might open prematurely during pregnancy. In some cases, an ultrasound image can lead to the diagnosis of incompetent cervix, but most often, the condition is not discovered until a woman has lost a pregnancy, usually in her second or third trimester. “It is estimated that incompetent cervix is responsible for 25 percent of all second-trimester miscarriages,” says Dr. Traci Kurtzer, an obstetrician-gynecologist with ENH Medical Group in Deerfield, Ill.

Cervical cerclage has become the standard treatment for incompetent cervix.

“The diagnosis is a challenging one. A history of multiple second-trimester deliveries or progressively earlier deliveries in successive pregnancies might be an indicator. A physician might also be more observant for signs of the incompetent cervix in patients who have had cervical trauma or surgery, who have had exposure to the drug DES in utero, or who have other congenital defects in the uterus or cervix.”

During the 22nd week of a pregnancy that was going very well, Alvarado knew something was terribly wrong when she found pink mucous on her toilet tissue one morning. She’d done enough reading during her pregnancy to recognize that the discharge may have been a sign that her mucus plug had dislodged. “I drove myself to the hospital and, much to my surprise, the doctor determined that I was 4 centimeters dilated and the amniotic sac had partially descended through my cervix,” says Alvarado. In addition to excessive discharge, vaginal bleeding, pelvic pressure, and heaviness in the lower abdomen are also cited as possible symptoms of incompetent cervix.

Alvarado was given two options: The doctor could attempt a procedure known as a cerclage, or they could keep her tilted (with her head below her feet) for as long as possible. She knew that it was much too early for her baby to be born, and hoping for the best outcome – but understanding the gravity of the situation – she and her husband chose the emergency cerclage.

Cerclage is a surgical procedure that involves stitching the cervix closed. “Cervical cerclage has become the standard treatment for incompetent cervix,” says Dr. Kurtzer. “But this procedure is not without risks, including bleeding, infection, and miscarriage, so it is important for a woman with this condition to talk about the risks and benefits with her obstetrician.” If optimal conditions are met, cerclage, which is most often performed as a precautionary measure at the end of the first or the beginning of the second trimester, has proven a very effective treatment.

Alvarado’s doctor warned her that the emergency cerclage might not be effective due to the severity of her condition, but knowing it was her only chance to save the pregnancy, she decided to proceed. “The doctor made a brave attempt, but my contractions got worse as my cervix was disturbed,” says Alvarado. Her baby was stillborn one hour later. Alvarado was devastated. “I had awoken that morning to the happy feeling of my baby’s kick, and the same night I had to go to bed with him gone forever.”

Alvarado’s traumatic experience had one positive outcome. She and her health care practitioners now knew that she suffered from incompetent cervix. In future pregnancies, all necessary precautions would be taken, and various treatment options employed. In addition to cerclage and frequent examinations of the cervix, treatment includes varying degrees of bed rest and the use of drugs to calm the uterus and stop contractions (if they are present).

When Alvarado became pregnant for the second time, a cerclage was performed early in her second trimester. This, combined with bed rest, frequent monitoring and the periodic administering of medication to stop contractions, allowed Alvarado to carry her second baby for 35 weeks, at which time the cerclage was removed. One week later she went into labor and delivered a healthy baby boy. During her third pregnancy, a cerclage was again performed early in the second trimester. This time, however, Alvarado was only able to make it to the beginning of her third trimester before giving birth to a baby girl. The weeks that followed were anxious ones for the Alvarado family, but their daughter grew stronger and healthier as each day passed and by the time she was released from the neonatal intensive care unit, the prognosis was excellent. “Looking at my daughter today, you would never guess that she had been a micro-preemie!” says Alvarado. “At age 3, she is just like any other happy, healthy toddler.”