"I’ve just had a miscarriage due to an incompetent cervix. Can I still have a baby?"
The cervix (from Latin, meaning neck) is lower part of the uterus, it measures about one inch long. The bottom of the cervix is convex in shape, and can vary in size. I think of it more like a door than a neck, or maybe a gatekeeper… It connects the vagina to the uterus, and it allows sperm into the uterus, and menstrual blood and babies out of the uterus.
So what happens if your cervix can’t do its job? If the cervix is not able to resist the pressure and weight of the growing baby, it may open, allowing bacteria and germs into the uterus that would normally never get there. This can cause a uterine infection, or an infection in the amniotic fluid, both of which, untreated, will be fatal to the fetus. The other possibility is that the cervix will actually “give way,” and premature labor will begin. The amniotic sac can rupture, and the baby may actually start down the birth canal, and if this occurs too early in the pregnancy, the baby will not be able to survive.
The bad news is that some women won’t know they have an incompetent cervix until it is too late, and they have had a miscarriage. The good news is that the problem is easy to fix, and subsequent pregnancies should be able to go full term. (And there are some cases where doctors will be able detect that the cervix is incompetent during routine examination). If your doctor suspects that you have an incompetent cervix, a simple procedure called a cerclage can be performed, which involves stitching the cervix shut. The most common cerclage is a drawstring type of stitch, and pulls the upper portion (closest to the uterus) of the cervix closed. This usually takes place between the 3rd and 4th month of the pregnancy. If the cervix is still threatening to open, your doctor may recommend bed rest to keep gravity and the increasing weight of your baby from putting pressure on the cervix and possibly tearing the sutures, thus starting premature labor. The stitches remain in place until about week 37, when your doctor will remove them. Labor can begin at any time after that. Between 80 and 90% of pregnancies with preventative cerclage go full term, and about 50% of pregnancies that require an emergency cerclage go full term.
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