The Importance of a Cervical Check During Early Pregnancy
This post is going to discuss something extremely important to all pregnant women. If you are one or you know any, make sure you/they read this. This is a Rated “PG” post. No cussing involved.
For once.
I was diagnosed with a short and funneling cervix at 19 weeks at my formal ultrasound for my girls. You read my story beginning here. I write this post in hopes that more women will become aware of this issue and get the measurement that can save babies lives. It is important to get it early because there is such a thing as too late for some treatments. DISCLAIMER: The information in this article is not to replace proper medical treatment from a licensed professional. Everything in this article was expressed to me by my own doctor’s as well as recommended studies that I have linked to within this article.
Ok, so your cervical length is a very important to your pregnancy. The cervix is the “neck” of your uterus. Essentially, it is a long opening that leads to your uterus. A typical cervix measures between 5cm and 7cm and is long and firm throughout most of your pregnancy, unless, you are like me. An “incompetent cervix” is found in 1 in 100 pregnancies. The danger zone is considered anything below 3cm before 36 weeks.
An “incompetent cervix” is one that is well, incompetent, meaning it begins to weaken and shorten too early in the pregnancy. The cervix is a muscle that keeps everything in its place. During pregnancy, it should be nice and tightly closed, keeping your bundle(s) of joy nice and snug in the uterus. Having an incompetent cervix may cause premature labor. For this reason alone, it is imperative that you demand an early scan of your cervix.
Who is at Risk?
Early detection of an incompetent cervix is imperative in helping to prevent pre-term labor. Most of the time, the cause for premature labor is not understood. A cervix that begins to shorten during early pregnancy can be a sign of damage that has been done to the cervix from:
- surgery performed on the cervix (a cone biopsy one such surgery)
- Malformed uterus or cervix from birth defect
- Trauma (such as a D&C performed for an abortion or miscarriage)
- damage from a previous birth that was difficult
It is important to note here that while an incompetent cervix is often associated with some sort of trauma, many times there is no detectable reason why the cervix fails in early pregnancy.
Multiple Gestation and an Incompetent Cervix
Women with multiples are at a far greater risk for a weakening cervix during the later weeks of the first trimester, but especially in the early weeks of the second trimester. Not much is known about this phenomenon, but it is believed that due to the increased weight of a multiple gestation along with a uterus that is far larger than a woman with a singleton pregnancy at the same time period, causes premature labor. It is as if your body thinks it is perhaps 7+ months along instead of the 5 months you truly are.
It is also thought that the increase in fertility treatments in conjunction with a multiple pregnancy may cause pre-term labor. A woman who undergoes fertility treatments that involve a drastic increase in hormones due to injections of Gonadotropins is believe to be at higher risk for a weakening cervix and premature labor.
While a check of the cervix is not routine, it should be. Only 1-2% of pregnancies are complicated from an incompetent cervix and many of those continue to be successful, yet 25% of second trimester miscarriages or premature births are caused from a shortening cervix. So, while doctors believe the percentage of these complications is very small, they need to look a mother in the eye who was not diagnosed early enough and lost her child(ren) at 22 weeks from an incompetent cervix.
There is no guarantee that early detection will lead to a successful pregnancy, but having a much greater chance of success because of early detection is much better than not being given a chance at all. EVERY DOCTOR SHOULD MEASURE THE LENGTH OF THE CERVIX AT YOUR FIRST APPOINTMENT.
How do They Measure the Length of Your Cervix?
You should demand a cervix length check at your very first prenatal appointment. Most OBGYN’s these days will give you an early ultrasound at your first appointment, to determine the due date of the bab(ies)y. This will most likely be
done with a transvaginal ultrasound, as the pregnancy is still in its very early stages. During this appointment, make sure they measure the length of your cervix to establish a baseline.
If you doctor does not do an early ultrasound, typically around 8 to 10 weeks, then demand one. If they cannot provide you with that level of care, find someone who will. Any medical office that caters to pregnant women will have the equipment needed to perform this type of measurement. If they do not, then you should switch immediately to someone who can provide up-to-date medical care for pregnant women.
What Can be Done if You Are Diagnosed With an Incompetent Cervix
While there is no treatment for an incompetent cervix that is proven to work 100%, there are steps that can be taken in order to help encourage the pregnancy along to a “safe zone” where the baby or babies can be born with little to no problems. It is important to understand that depending on how many babies you are carrying will determine the best course of action. For a woman with a singleton pregnancy, if the problem is diagnosed early enough (say before 19 or 20 weeks) a cerclage is recommended along with bed rest. There are many forms of bed rest and your doctor will recommend the type you need depending on the stage of your pregnancy and the measurement of your cervix.
Treatments for Pregnancies of Multiples
If your doctors are not very familiar with pregnancies of twins or higher, it is EXTREMELY important that you find someone who is if you are pregnant with multiples. At the very least, read this study or direct your doctor to this information before they decide on the best course of action for your pregnancy. Today, a cerclage is NOT recommended in twin pregnancies because the risk of membrane rupture and infection far outweigh the possible benefits of a cerclage. This has been a surprising and often resistant change in the way things are carried out in regards to a short cervix.
Currently, the best form of treatment for a cervix measuring below 3.0 cm in a twin or higher order multiple pregnancy is thought to be progesterone treatment and strict bed rest.
Recommended Steps to Take to Save Lives
- Ask your doctor for a cervical length check at your first OB appointment somewhere between 6 and 8 weeks.
- Ask for another cervical length check around 13 to 14 weeks. This is a good time to put in a cerclage if one is needed with lower risks. Waiting to find out at your formal ultrasound, like what happened to me, can often be too late for treatment.
- If everything was fine at the previous check ups, make sure your cervix is measured at your formal ultrasound around 20 weeks. Sometimes a rescue cerclage will be attempted at this date (best only if you have a singleton), but you have reached the danger zone for a cerclage at 20 weeks and it much better to the short cervix earlier if possible.
- Always, always, always follow your doctor’s recommendations, but please ask questions and demand to speak to a Maternal-Fetal Medicine specialist as well.
Please remember that while this article seems scary, many women have an incompetent cervix and never know it and go on to deliver full term babies. However, this is something that is possible to catch early on if you are aware of the issue and ask your doctor about it. Do not let them sway you with low statistics of probability if it is something you are truly worried about. Always keep in mind that it is your pregnancy and the life of your child at stake. A trans-vaginal ultrasound takes all of five minutes to perform. There should be no reason that one cannot be performed, no matter how low the “risk”.
My story did not have a happy ending, but that does not mean that someone else cannot have one. We really have no idea what happened in my pregnancy. There is never a guarantee, even with treatment, a cerclage and bed rest. However, come armed with knowledge and give yourself and your bab(ies)y the best chance available.
xoxo
Thank you for an informative article! I too did not have a happy ending with an incompetent cervix or a rescue cerclage. I really wished I would have known to ask before it was too late. I feel it is important to continue to spread the word to others so that losing a baby does not happen to others who can be aware of their situation ahead of time.
Thank you for reading and for your comment. I am sorry for your loss. Those of us who experience such things need to stick together and raise awareness. Please spread the word
I just returned from the hospital today. My significant other was at 21 weeks and started having contractions last night at work. We went to the ER and she went into labor and we lost our baby girl because of an “Incompetent Cervix”. We did not get ANY measurements at ANY time as far as I know but will find out when we return to the doctor. I am currently still traumatized by the whole thing but I have this question:
IS IT REQUIRED BY LAW FOR DOCTORS TO HAVE THIS SIMPLE TEST DONE REGARDLESS OF STATISTICS (1 in 100)?
I feel that if it were a requirement… I wouldn’t be visiting the funeral home tomorrow. This is ridiculous to think that even with such a small statistic or even if one is placed in a low risk category… measurements of the cervix with EVERY doctors visit is not utilized.
Lei, may you find peace amidst tragedy as I too am searching.
Email if you like:
dushud@yahoo.com
I am so sorry for the loss of your baby girl. As you know, I can relate.
No, it is not required by law to check the cervix, but I think it is routine at your formal ultrasound at around 20 weeks. Many times the technicians and doctors do not even tell you they are checking the cervix, or if they do and find nothing wrong, they do not tell you the length.
Everyone should ask for this to be performed early and ask the length so they know. Right now my cervix is 5cm and I am 12w pregnant with twins again.
I agree that it should be required, but since it does not seem to be then that is why I want people to see this post and demand it.
Again, I am sorry for your loss and feel free to email me through the contact page (you or your significant other) because I know exactly what you are feeling right now and what is to come.
I did find peace but that doesn’t mean I do not struggle. The best piece of advice I can give you is to not get lost in your own grief completely and be there for each other. This is much easier said than done and the male typically is more neglected in these situations, but know that I am here for you as well as many other baby lost parents.
You can expect irrational thoughts and guilt, but that will get you guys nowhere. You had no idea and no reason to believe anything was wrong. Typically an incompetent cervix is NOT diagnosed until around 18-20 weeks anyway when the baby begins putting more significant pressure and weight on it. Many people only see their doctor 1 time a month unless they have a reason to go more often.
I went every 2-3 weeks because I had twins and gestational diabetes and they still didn’t catch it until 19 weeks, but I don’t think they even looked until then either.
So maybe the solution is to get the cervical length check at every early appointment then go more often between 18 and 24 weeks.
I just dont know, but I wish you all the best and send my love to you two during this time of grief.
Take care.
xoxo
Lei
This is FANTASTIC post about cervical incompetence. After losing my daughter, Claire, because of it I encourage everyone I know to be assertive during the treatment of their pregnancy. My doctor did do a cervical check at 18 weeks and I measured 3.6 which was not considered dangerous. Had I had another one at closer to 20, it’s likely we would have seen some dramatic changes but lacking any suspicious cervical activity, my OB had no reason to suspect my cervix would fail. It’s frustrating to know that the condition can be caught, but it has to be monitored to closely. Spreading the word is the first step to helping save another family from going through this pain. Great job!
thank you so much for posting this. it was really touching for me because i have incompetent cervix. i have two sons already and i been trying for my third for about three years now. i been pregnant three times in the past three years and i lost all of them due to incompetent cervix. one at 16 weeks one at 18 weeks and the last at 20 weeks just this january. i believe if the started me the the progesterone treatment a little earlier them my baby wouldve survived. my water broke the day before the treatment was supposed to start and i had already got the cerclage at 13 weeks. very depressing and i just really appreciate u posting this up here. we will be trying again very soon..dont give up hope. there is a God and it will happen
I was 21 weeks and went into labor, and delivered a stillborn little boy. No one can tell me why. But everything I’ve been reading about this post and incompetent cervix sounds so much like what happened to me. Please I would love to hear from anyone about they’re experience because I feel like if I talk to the doctor about it before knowing for sure if that’s a possibility, that he may tell me to stop obsessing over it and just let it go…People have been telling me God has a reason, and I agree and believe that, but looking at it with a scientific view, something physical went wrong, and I want to know what happened. or at least TRY.
I’m so sorry for your loss. Just to clarify, those who go on to deliver full-term babies without intervention most likely do not have an incompetent cervix as “incompetent” inherently means it was not able to carry the baby to term. If the cervix is shorter or weaker than normal, but perfomed its duty so to speak, it’s not considered incompetent. I think it’s important to point that out.
Just wanted to add another treatment option for those with an incompetent cervix. There us a procedure called TransAbdominal Cerclage or TAC you can find info by searching either if those name and IC. There is also a yahoo group called abbyloopers that has a huge amount of information. The surgery isn’t common as it is major abdominal surgery similar to a csection. But there are very skilled doctors around the country that perform the TAC. Specifically dr Davis in new jersey and dr Haney in Chicago. The TAC is basically a band that closes the cervix permanently right at the mouth of the uterus where the cervix and uterus meet. Because the band us placed so high your cervix can not open therefore preventing early delivery. You can have a TAC placed pre pregnancy and post pregnancy. I will be having mine placed next Friday with dr Davis in new jersey. The sucres rate of the TAC is 93-98% sorry for the book. I hope that someone sees this and can be helped by the information.