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Incompetent Cervix

To diagnose an incompetent cervix, your doctor may perform either a manual exam or an ultrasound. If these show your cervical opening is greater than 2.5 cm, or the length has shortened to less than 20 mm, and you're less than 24 weeks pregnant, your doctor may recommend you have a cervical cerclage, a procedure in which a band of strong thread is stitched around your cervix to reinforce it and help hold it closed. Cerclage successfully treats incompetent cervix 85 to 90 percent of the time, especially if performed early in a pregnancy. The best time to perform a cerclage is between 13 and 16 weeks, before the cervix starts to change.

While cerclage can save the baby's life in many instances, it also has potential risks and may cause preterm delivery, infection, uterine rupture, maternal hemorrhage, bladder rupture, cervical laceration, preterm labor and premature rupture of the membranes. However, the likelihood of these complications occurring is minimal and most health care providers feel that a cerclage is a life-saving procedure that is worth the risk.

Cerclage is performed using a general, spinal, or epidural anesthetic. Your doctor may give you medication to prevent infection or preterm labor, and she'll continue to check your cervix regularly for signs of further changes until the stitches come out, usually at 37 weeks. Once the cerclage is removed, labor and delivery should proceed normally, or your cerclage may also be left in place and the baby can be delivered by c-section.

Cerclage is not for everyone. Some women are ineligible for certain reasons, including:

  • hyperirritability of the cervix
  • the baby has already died
  • her cervix is already dilated more than 4 cm
  • her water has broken

Some caregivers prescribe bedrest in addition to - or instead of - cerclage. Although there's no solid evidence that staying in bed is effective, the theory is that keeping the weight of the uterus off of a weakened cervix might help.

If you've had a cerclage and experience any of the following symptoms, call your doctor immediately:

  • Vaginal spotting or bleeding
  • Your amniotic sac begins leaking or breaks
  • You have a temperature over 100.4 degrees F (38 degrees C)
  • You have signs of infection, including chills, a cough, or if you feel weak and achy.

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