Incompetent Cervix 101

[IrelandsMama]

I have some questions about incompetent cervix. I'm a very new doula and my hair dresser was telling me today that she has an incompetent cervix (gosh that term makes me sad) and that she had her daughter very premature because of it. She also said she had a cerclage but it didn't work and neither did bed rest. She told me shes doing pelvic exercise to strengthen herself.

I know next to nothing about incompetent cervix except that the cervix doesn't do a good enough job of keeping baby in, and baby is born too early. Is there anything a mom can do about this? I need to do some major research but I just figured you ladies could point me in the right direction.

Thanks

sav

[onlyAngil]

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[kate3]

IC occurs due to some kind of damage to the cervix. It was almost universal in DES daughters. Now the leading cause of IC is treatment for HPV related abnormal paps. When a portion of the cervix is removed during LEEP or cone biospy, the cervix is shorter and weaker. Around 19-21 weeks when the baby starts to put a more significant amount of weight on the cervix, it is unable to hold and dilates, with or without ruptured membranes.

Once the cervix begins to thin and dilate putting in a cerclage is not that effective. An effaced cervix is too thin to hold a stitch and prevent delivery.
Unfortunately, IC is most often diagnosed after a loss. In subsequent pregnancies a cerclage can be placed around 13-14 weeks when the cervix is thicker.

Now that we know that women who have had extensive treatment for cervical HPV are at high risk for IC, many docs will do serial sonos for cervical length. At the first sign of shortening a cerclage can be placed prior to significant change. Even with a cerclage, premature labor and needing labor suppression are common.

That's it in a nutshell. Pelvic exercises work on the pelvic floor muscles, not the cervix itself.

[crazydiamond]

Unfortunately it is true that IC isn't usually diagnosed until after a loss. So sad

There also seems to be a lot of IC losses/diagnosis in PCOS women, though that's just my personal observation on the internet. Although it hasn't been recognized by the medical community at all, a few women have reported that their OBs hold a theory that the hormonal imbalance that's common to PCOS women (mainly, low progesterone in the 1st trimester) plays a role in IC. Who knows though.

From what I know, the best chance for a positive outcome in subsequent pregnancies is a cerclage placed early (12-15wks), strict bedrest for the duration of the pregnancy, and frequent sonograms to determine cervical length.

Even when IC is suspected (or even confirmed from a prior loss!) many OBs will prefer to take the "wait and see" approach. That is, they may do frequent sonograms to monitor cervical length and only opt to place the cerclage once it's clear that the cervix is shortening. The problem with this approach is that the shortening isn't always gradual. . it can go from 4cm with no funnelling to fully effaced with a bulging bag in a day. This approach is the standard of care, though, which might explain why most women suffer a loss before they get properly diagnosed and different treatment in subsequent pregnancies.

[mothercat]

There are other things that can be done beside just a cerclage.
I am a CNM but also work at the Perinatology Research branch in Detroit. Dr. Romero was the researcher, with his team, back in the early '90s who figured out that infection was one of the most frequent culprits in preterm labor, premature, preterm rupture of membranes, etc. and his work was cited by Saling in Germany.
Here is the link to the prematurity prevention project:
http://www.saling-institut.de/eng/04...2programm.html

It is really interesting stuff but here are the basics:
Women need to self check their vaginal pH twice a week. If they notice a shift, they go to their doctor to have this confirmed and if there is the beginning of a shift in vaginal flora (the beginning of bacterial vaginosis) they are given treatment such as Flagyl or Clindamycin, but more importantly immediately started on probiotics to bring the bacterial flora balance back to normal. They are on limited activity for 2 weeks because it may take the probiotics that long to correct the pH. The shift to an abnormal flora leaves the vaginal/cervical area open to more serious infection like strep or the dozen or so that cause chorioamnionitis.

For women that have an IC or symptoms indicating they may have an extremely preterm baby, early Total Cervical Occlusion is recommended. With this the woman has a cerclage placed early, but then the edges of the cervix are roughed and oversewn so that as they heal they totally occlude the opening. One of the big problems with regular cerclage is that the cervix is still a bit open and bacteria can continue to ascend causing inflammation to the cervix, amniotic sac, etc. and cause pretem labor or PPROM. With the total occlusion the cervix is sealed and this is less of a problem.
So, the question is what happens with labor. The cerclage is removed and the scar tissue is easily broken up and labor proceeds as normal.

Few doctors here have heard of this, but if you read through Saling's stuff there is also a self care program that women can start to care for themselves even if the doctor/midwife is ignorant. And don't forget the value of adequate protein and a good diet to assist the immune system in fighting off any infections and minimizing the effects of stress.

There is much more on the web site and their numbers are really good.

Linda

[IrelandsMama]

Thanks Everybody!

Sorry I forgot to shout back a thanks. I was really happy to have the links and the info. This will be a big relief to my friend who thinks there is nothing she can do to manage a future pregnancy. It's just a shame that OB's didn't clue her in so she wasn't sitting around thinking this all along.

sav