 |
 |
|
|
|
|
DESCRIPTION
The cervix is the neck of the womb that connects the vagina with the uterus. Women who are diagnosed with an incompetent cervix experience premature opening (dilation) of the cervix usually in mid-pregnancy (18 to 22 weeks). Normally, the cervix remains closed throughout pregnancy until labor begins. The condition occurs in about 1 out of every 100 pregnancies and may be responsible for 20 to 25% of second trimester miscarriages. The miscarriage occurs after the uterus has enlarged somewhat and the developing fetus becomes heavy enough to press the cervix open.
FREQUENT SIGNS & SYMPTOMS
No signs and symptoms are usually apparent. In a pregnant woman, there is a gradual thinning and dilation of the cervix usually without vaginal bleeding or uterine contractions.
In some cases, a woman may experience pressure in the lower abdomen or vaginal pressure, unusual urinary frequency, vaginal discharge (with or without blood), or a sensation of a lump in the vagina.
CAUSES
The cervix may be weakened by injury (trauma), previous childbirth, induced abortion, forced D & C (dilation and curettage) surgery, cervical surgery or laser therapy. There are rare conditions in which the substance of the cervix is not strong enough to support a pregnancy. Hormonal influences, uterine abnormalities, or congenitally short cervix may cause cervix incompetency problems.
RISK INCREASES IN/WITH
Multiple gestation (e.g., twins, triplets).
A woman who was exposed to DES (diethystilbestrol; a drug once used to prevent miscarriage) when she was in her mother's womb.
PREVENTIVE MEASURES
If a woman experiences a miscarriage that is diagnosed as being caused by cervical incompetence, there are preventive measures that can be taken with a subsequent pregnancy to reduce the risk of another miscarriage.
EXPECTED OUTCOME
If diagnosed with a previous miscarriage and with proper treatment in the subsequent pregnancy, chances of carrying to term are good.
POSSIBLE COMPLICATIONS
Repeated miscarriages and fetal death.
Premature delivery of prematurely developed infant with all the problems that often accompany prematurity.
TREATMENT
GENERAL MEASURES
DIAGNOSIS
Diagnosis is determined by a history of repeated miscarriages, an internal pelvic examination, and by ultrasound scanning. The use of ultrasonography has been very helpful with the diagnosis, and is made when the cervical os (opening) is greater than 2.5 cm, or the length has shortened to less than 20 mm. Sometimes funneling is also seen, this is where the internal portion of the cervix, internal os (portion of the cervix closer to the baby) has begun to efface. The external os will be unaffected if diagnosed in time. An incompetent cervix may also be corrected in a non-pregnant woman.
TREATMENT
Treatment involves the placing of a stitch or suture (cerclage) into the wall of the cervix and drawing it up (similar to a purse string). This helps hold the fetus in the womb. The procedure is normally performed under regional anesthetic or sometimes local anesthetic at about the 12th to 14th week of pregnancy. The stitch is removed shortly before the baby is due or at the time of delivery (depending upon the midwife's or health care provider's preference) so a normal delivery can take place. Stitch removal is simple and does not require anesthesia.
For diagnosis made during pregnancy, you must meet certain criteria before a cerclage can be performed. You are not eligible for the cerclage if you have:
- Hyper-irritability of the cervix.
- Your baby has already died.
- You are more than 4 cm dilated.
- Your water (amniotic bag) has broken.
CERCLAGE
There are five different techniques for performing the cerclage. The two most common are the McDonald and Shirodkar.
The McDonald procedure is done with a 5 mm band of permanent suture is placed high on the cervix. This is indicated when there is significant effacement of the lower portion of the cervix. It is generally removed at 37 weeks, unless there is a reason to remove it earlier, like infection, preterm labor, premature rupture of the membranes, etc. It is also shown that this has very little impact of the chance for vaginal delivery.
The Shirodkar is also used a frequently used technique. However, this was previously a permanent purse string suture that would remain intact for life. When this type of cerclage is done, a cesarean section will always be performed.
There are health care providers performing modified techniques, where the delivery does not necessarily have to be by cesarean, nor the suture left intact. Ask your practitioner which procedure they perform.
The Hefner cerclage, also know as the Wurm procedure, is used for later diagnosis of the incompetent cervix. It is usually done with a U or mattress suture, and is of benefit when there is minimal amounts of cervix left.
Uterosacral cardinal ligament cerclage is generally done after the McDonald and Shirodkar procedures have failed, or where there is a congenital shortened cervix, or subacute cervicitis. It can be done vaginally, but is frequently done abdominally. Again, cesarean delivery is mandated for birth.
The last procedure, the Lash, is performed in the non-pregnant state. It is typically done after cervical trauma that has caused an anatomical defect. There is the possible, though rare, side effect of infertility.
While these procedures are life-saving, they also have potential risks:
- Premature rupture of membranes (1-9%).
- Chorioamnionitis (Infection of the amniotic sac, 1-7%) (This risk increases as the pregnancy progresses and is at 30% for a cervix that is dilated more than 3 cms.)
- Preterm Labor.
- Cervical laceration or amputation (This can be at the procedure or at the delivery, from scar tissue that forms on the cervix.)
- Bladder Injury (rare).
- Maternal hemorrhage.
- Cervical dystocia.
- Uterine rupture.
The procedure is generally to observe the woman for 24 hours before performing the cerclage. During this time she will be observed for preterm labor and screened for infection. Generally this is done with the woman in the Trendelenburg position, feet above your head. Spinal anesthesia is used to prevent pain and maternal straining during the cerclage. Your bladder will be filled to try and move your membranes away from the os. You will be given antibiotics to help stave off infection, and Indocin to help your body ignore the prostaglandins released during the procedure.
Post-operatively you will be on bed rest for the next 24 hours, possibly in the Trendelenburg position. And monitored for uterine activity.
Once released from the hospital you will be on pelvic rest (no sex) for the remainder of the pregnancy. You will need to have periods of rest each day and decreased physical activity. You will be seen in the office at least once weekly until the birth. You will also be monitored for preterm labor. If you have any contractions you should contact your health care provider or midwife.
Cerclage seems to be a very effective treatment for incompetent cervix. The success rates can be very high (80-90%), particularly when done earlier in a pregnancy. If you have concerns about your prenatal history or suspect an incompetent cervix ask your practitioner to examine you.
OTHER OPTIONS
Bed rest and use of a uterine support (pessary) for the duration of the pregnancy may be recommended instead of the surgical procedure.
MSN Incompetent Cervix Support Group
MEDICATION
Medication is not necessary for this disorder.
ACTIVITY
Bed rest for 24 hours following the cerclage procedure. Additional restrictions may be recommended by the midwife or health care provider. See Bedrest Checklist, Bedrest - Coping Techniques, Bedrest Exercise, Bedrest Family Tips for more information about dealing with required bedrest during pregnancy.
For some women, sexual intercourse may be restricted for the duration of the pregnancy.
DIET
No diet restrictions; continue with your recommended pregnancy diet.
Beneficial Dietary Supplements For Miscarriage:
- Raspberry helps strengthen the uterus and may be taken as a tea.
- False Unicorn helps strengthen the uterus.
- Wild Yam helps improve hormonal balance for maintaining pregnancy.
- Prenatal Vitamin Supplements provide general nutrition, which is very important for fetal development and to support pregnancy.
- Folic Acid helps prevent birth defects and supports pregnancy.
- Vitamin C with Bioflavonoids strengthens blood vessels.
- Vitamin E helps balance hormones.
MISCARRIAGE SUPPLEMENTAL PRODUCTS
Information, supplements and products for miscarriage, the loss of a pregnancy during the first 20 weeks.
Vitamin C 1000 with Bioflavonoids, Nature's Way, 100% Natural, 1000mg - 250 Vcaps
Nature's Way Vitamin C with Bioflavonoids provides antioxidant protection for many of the body's important enzyme systems.Miscarriage Tincture (Helps Prevent), 100% Organic - 2 fl. oz.
The Miscarriage Tincture was created to help prevent miscarriage.Pregnancy Tonic Daily Tea, 100% Organic - 1/2 lb.
Pregnancy tea for nutrition, toning and preparing for birth. 1/2 to 1 cup 3 times daily.Pregnancy Tonic Tea 37th Week - 1/2 lb.
A tea to be used from the 37th week of pregnancy to help prepare for an easy, healthy birth.Folic Acid (Vitamin B 9) 100% Natural, Nature's Way 800mcg - 100 Caps
Folic acid (Vitamin B 9) is necessary precursor for the manufacture of genetic material like RNA and DNA. It also assists in the growth and repair of tissues and in the conversion of fats and amino acids into other useful products in the body.Prenatal Vitamin with Folic Acid, 100% Natural & Complete Nature's Way - 180 Caps
Nature's Way Prenatal Vitamin with Folic Acid is a complete vitamin formulated to support the health of the mother and child.False Unicorn Tincture, 100% Organic - 2 fl. oz.
Many herbalists recommend False Unicorn for reducing menopausal symptoms, and treating ovarian cysts. It has also been used to normalize hormone levels following oral contraceptive use.CapsiCool, Cayenne Formula, Nature's Way 780mg - 100 Caps
Cayenne has been one of the world's most popular herbal supplements since the time of the early Peruvians. CapsiCool is a special formulation that provides the benefits of Cayenne without the burning feeling and discomfort in the stomach that otherwise may be experienced.Blue Cohosh (Caulophyllum thalictroides) Tincture, 100% Organic - 2 fl. oz.
Blue Cohosh is used to regulate the menstrual flow and for treating suppressed menstruation.St. Johns Wort Herb Tincture, 100% Organic - 2 fl. oz.
St. John's Wort is mainly used for the treatment of mild to moderate depression.Wild (Mexican) Yam Tincture, 100% Organic - 2 fl. oz.
Wild Yam has been used to treat indigestion, coughs, morning sickness, gall bladder pain, menstrual cramps, joint pain, and nerve pain.Wise Woman Herbal For The Childbearing Year By Susun S. Weed, Janice Novet
This is a complete herbal pharmacopoeia for dealing with every problem that might arise before, during and after pregnancy and childbirth. Simple, safe, remedies for pregnancy, childbirth, lactation, newborns. Includes herbs for fertility and birth control.
NOTIFY YOUR MIDWIFE OR HEALTH CARE PROVIDER IF...
You or a family member is pregnant and experience any new or unusual symptoms such as cramps or spotting.
Signs of infection: pain on urination, frequent urination, or a general ill feeling and fever.
Mountain Rose Bulk Herbs
Mountain Rose Aromatherapy Oils
Mountain Rose Herbs, Aromatherapy Oils A-B
Mountain Rose Herbs, Aromatherapy Oils C-E
Mountain Rose Herbs, Aromatherapy Oils F-L
Mountain Rose Herbs, Aromatherapy Oils M-P
Mountain Rose Herbs, Aromatherapy Oils Q-Z
Mountain Rose Herbs, Aromatherapy Oils: Oil Blends & Resins
Mountain Rose Herbs, Aromatherapy Oils: Diffusers, Nebulizers, & Burners
Mountain Rose Herbs, Aromatherapy Oils: Oil Kits
Click Here To Visit Herbal Remedies Product Page
