PREGNANCY-BIRTH Messages for March, 1999: Re: incompetent cervix

Re: incompetent cervix

From: Jas (anonymous@obgyn.net)
Thu, 25 Mar 1999 21:44:39 -0600 (CST)

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At Thu, 25 Mar 1999, ck wrote: >
>I was diagnosed with an incompetent cervix with my second pregnancy
>through a 2 level ultrasound. The radialogist(not a gynocologist)
>diagnosed this and said that mine was not a bad case .I had a cerclage
>at 14 weeks and was on Brethine and had a normal babay at 39 weeks.
>Now I am pregnant again and my doctor (a different one since I moved out
>of the state) says that it was a wrong diagnosis and that a cervical
>incompetence cannot be detected through a 2 level ultrasound.
>I need to know how I need to address this. Firstly 1)what lengths of
>cervix is considered an incompetent cervix. 2) How can it be correctly
>diagnozed. 3) Should I insist on a cerclage 4) Are the chances of
>incompetence graeter in the scond pregnancy.5) I had a fairly short
>labor the first time(4 hrs) and my cervix went from 2 to 10 cm in 30
>minutes. Does that indicate that I had an incompetent cervix 6) I
>delivered two days after my cerclage was removed. Does that mean my
>cervix was indeed incompetent.
>
>I had to terminate my first pregnancy because of a child with severe
>anencephalia and spina bifida, and the second pregnancy was fine. Want
>to make the right decision on the incompetence this time to make this
>pregnancy work
>Just a lot of questions and wanted some help on what I need to do.

Dear CK,

First let me say ~*~*Congratulations~*~*~ on your new pregnancy!

I will try to take a stab at some of your questions and then hopefully the Drs. here will also come to your rescue. I have dealt with a long history of incompetent cervix for the last 7 yrs of my life. This past Jan. I finally had baby number 2 out of 5 pregnancies. I will share with you what I know from my experiences and knowledge from my perinatologists to try and respond to some of your questions.

>incompetence cannot be detected through a 2 level ultrasound.

Well not necessarily, on an u/s you can in fact see funneling of the membranes which can be a red flag of an IC. You also can take cervical measurements of the cervix which can show a short cervix. I don't believe using just u/s can be enough to diagnose an IC. I had several HSG tests in addition to a dilation internal test (sorry don't know the official name of the test that involved inserting rods of different sizes into the cervix). I don't think any Dr. can look at a scan and say "Oh you have an IC" I could be wrong though.

>1)what lengths of cervix is considered an incompetent cervix.

Cervical length is widely debated among Drs. Some say 3.0-4.0 is average. Some say 2.5 is concerning and some say 2.0 is very worrisome. The thing to remember about length is not what the actual length is but how quickly that length changes and during what week of pg. You can have a length of 2.0 have no change and go all the way to term w/out a cerclage. On the other hand you can have a length of 2.0 and that quickly changes to 1.5 and you got a more concerning situation. I was always told its the comparison of numbers, the amount of change, and how rapid that change is that is important.

>2) How can it be correctly diagnozed.

My peri followed my cervical change with u/s every 2-3 weeks and an internal every week of pregnancy. The sad thing about diagnosing IC is it usually isin't diagnosed until you have a second trimester loss occur. Even then its difficult to say for sure what really happened. It could be a number of things. It is difficult to say whether it was the cervix misbehaving or was there an infection that lead to PROM.

>3) Should I insist on a cerclage

That's a tough one. Not to scare you but cerclages are not cure all's. There is always the risk of infection during placement although this is a small risk in my opinion to the risk of losing another pg. Cerclages can fail sad to say. My first cerclage worked great. We did the same cerclage thing for the next pg and I miscarried. We tried again to place another cerclage and it pulled out at 21 weeks. Out of 5 cerclages (one of them a rescue) 2 worked. It would be best to sit down with your Dr. and carefully evaluate your history.

>4) Are the chances of incompetence graeter in the scond pregnancy.

History can always repeat itself. I know in my situation with each pg my cervix gets weaker.

>5) I had a fairly short labor the first time(4 hrs) and my cervix went from 2 to 10 cm in 30 minutes. Does that indicate that I had an incompetent cervix

To be honest I really don't think length of labor has anything to do with diagnosing IC. I had 12 hrs of labor with my first IC loss. 12 hrs with my second IC loss. I had 12 hrs of labor with one of my successful cerclage babies and 7 hrs of labor with the other success.

>6) I delivered two days after my cerclage was removed. Does that mean my cervix was indeed incompetent.

This I know for sure doesn't mean anything. I had a cerclage removed at 37 weeks and went on to need induction to get going during week 38. My latest baby I had my water break with cerclage in so delivery was shortly following removal.

Best wishes do you! I can relate to how difficult it is to know what to do for future pregnancies. It does seem like a trial and error type thing. One of the hardest things to accept is medicine is not an exact science and it can be a fine line between what is IC and what is not. There are actually Drs. out there that come from the school of thought that there is no such thing as an incompetent cervix and they feel cerclages are way overused. I searched and interviewed long and hard before I selected my perinatologist. I wanted to find someone who had yrs of experience with cerclages and specialized in second trimester losses. Find someone you trust and like and ask about experience.

Good Luck to you!

Jenn

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