BACKGROUND: As a baby grows in its mother's womb, it gets heavier and starts to press on the cervix. Normally, a woman's cervix opens with the beginning of labor after about nine months, but in some cases, the pressure may cause the cervix to open before the baby is ready to be born. This can lead to a miscarriage or premature birth; a condition referred to as incompetent cervix. According to the University of Chicago Medical Center, the condition occurs infrequently. An estimated 20 to 25 percent of all second trimester losses are attributed to an incompetent cervix. Many women don't know they have the condition until after losing their first pregnancy. Most of the time, the defective cervix is due to a birth defect that affects the normal shape of the uterus or cervix. Ultrasonography has been helpful in diagnosing the condition, which is done when the cervical opening is greater than 2.5 cm or the cervix length has shortened to less than 20 mm.
TREATMENT: The standard treatment for incompetent cervix involves placing a cerclage, or a band made of synthetic material, around the cervix. The cerclage strengthens the cervix as well as stops the amniotic sac from coming out early. There are different types of cerclages available. In a transvaginal cerclage (TVC), doctors sew the cervix closed, usually during the 13th or 14th week of pregnancy. At 36 weeks, the stitches are taken out so the woman can deliver her child naturally. A few downfalls exist with this method: It requires bed rest for the remainder of pregnancy, many babies are still delivered prematurely, and it needs to be redone with each pregnancy thereafter. TVC has around an 85 percent success rate.
A LIFESAVING OPTION: Another type of cerclage is transabdominal cerclage (TAC), which involves placing a synthetic band higher on the cervix. In this procedure, doctors make an incision in the lower abdomen, or it is done laparoscopically. This type of cerclage supports the cervix and prevents it from opening. Unlike TVC, it does not require the mother to be on bed rest; however, women who opt for this procedure can only deliver their baby through Caesarean section, performed through the same incision used to place the cerclage. Once the band is placed, it can remain safely in the body and be used for later pregnancies. According to Arthur F. Haney, M.D., a professor of obstetrics and gynecology at the University of Chicago Medical Center in Chicago, Ill., TACS can be placed up to 16 weeks of gestation, but it is best to place abdominal cerclages in the 10th week when the patient and baby have the lowest risk. Many patients opt to have the procedure done before they get pregnant. More than 95 percent of women with TACs who deliver via C-section have a successful term delivery.
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