Re: Incompetent cervix question for HSM (For Dr McIntosh)

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Hypothetically if a woman presented to you in L&D because they were worried about spotting they were having, upon exam advanced dilation say +4 +5was found with bulging membranes (not ruptured yet) no fever and painless contractions every 2-3 minutes. All effrots of meds to stop contractions failed therefor water breaks and delivery occurs. This all happening before 24 weeks (say approx weeks 16- 18). If you would never place a diagnosis of an incompetent cervix then what would you attribute the loss too? A chromosome error? Or do you diagnose the patient as loss due to infection everytime if its before 24 weeks? Could not funneling occur before 24 weeks and be seen via u/s and suspicion that it could be an incompetent cervix getting ready to rear its ugly head be made. Do you honestly believe that no loss before 24 weeks can be due to a cervical problem? Ever?

Thank you for any insight you can give

At Tue, 26 Dec 2000, William D. McIntosh MD wrote: >
>At Tue, 26 Dec 2000, fcb wrote:
>>
>>Your reply to the "Clerclage" posting made me wonder... You said that
>>an incompetent cervix after one procedure is rare as is incompetent
>>cervix without a previous procedure. I did have a D&C when I had a cyst
>>removed in '92. However, I carried my son to 38 weeks with no problems
>>in '97(the delivery wasn't pretty!). I have lost two (14weeks/17weeks).
>>How rare would it be to have an incompetent cervix after a vaginal
>>delivery(2 vacuums were used).
>>
>>Thanks,
>>fcb
>
>That would be just as rare as having an incompetent cervix from a
>spontaneous vaginal delivery, very, very low. The vacuum has no impact
>on the cervix, as it is not used until the cervix is completely dilated
>and out of the way. I am also not sure that a diagnosis of incompetent
>cervix can be made from 14 and 17 week losses, though I am not privy to
>all the details, and your own physician would know best. Still, losses
>that early are never or virtually never from cervical factors.
>Incompetent cervix usually kicks in after 24 weeks, and I have never
>heard of one before 20 weeks.
>
>--
>William D. McIntosh, MD, FACOG
>
>Intended for educational purposes only, and not intended to replace examination
> and consultation with a qualified medical professional.
>
>No private e-mails, please.
>

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