Cervical Insufficiency and Embryonic Resorption in Pregnancy

Cervical incompetence and embryonic resorption?

Hello: Last year, I had a miscarriage at 14 weeks of pregnancy.
The day before the miscarriage, I felt tightness in my uterus in the afternoon, followed by brown spotting.
I went to the hospital that evening, and the doctor said there was no major issue and did not prescribe any medications to support the pregnancy.
The next morning, the tightness in my uterus became more pronounced, and I experienced red bleeding.
When I arrived at the emergency room, the doctor suggested that the bleeding might have been caused by a polyp approximately 0.8 cm in size and also did not prescribe any medications.
However, in the afternoon, I experienced cramping, and by the time I reached the hospital, my water had broken, leading to an induction.
My question is: Can last year's miscarriage be attributed to cervical incompetence or poor uterine contractions? Additionally, my last menstrual period was on May 22, and I took ovulation medication from May 24 to May 28.
On June 1, I had a transvaginal ultrasound, and the doctor determined that June 4 was the ovulation day.
After intercourse on June 4, I noticed some bleeding that quickly stopped.
On June 10, after urinating, I found some blood on the toilet paper.
The doctor suggested it might be implantation bleeding (the polyp had been expelled during last year's miscarriage), so I started taking progesterone on the evening of June 10.
From the morning of June 11, I had continuous brown discharge until June 19 when I returned to the clinic.
The doctor advised me to stop taking progesterone and to monitor the situation after discontinuation.
However, I continued to have brown discharge after stopping the medication.

On June 22, I returned for a pregnancy test, and the doctor confirmed that I was pregnant, but one of the lines on the test was very faint.
Based on the ultrasound results from June 1, the doctor indicated that both lines on the pregnancy test should be clearly visible.
It was suggested that the previous bleeding might have caused the embryo to shrink, so there was no need for further medications to support the pregnancy.
The doctor mentioned that I might experience bleeding similar to a menstrual period within a week.

My questions are: Am I now left to wait for the bleeding? If I do bleed, will the embryo be expelled completely, or will I need a surgical procedure? After this failure, is it appropriate to continue taking ovulation medications? If the embryo is retained, does early bleeding indicate that the embryo may not be viable? I would greatly appreciate your responses to these questions.
Thank you very much!

lilian, 30~39 year old female. Ask Date: 2009/06/23

Dr. Chen Changfu reply Obstetrics and Gynecology

Early pregnancy loss studies indicate that the majority (about 70-80%) are due to chromosomal abnormalities in the fertilized egg, resulting in non-viable embryos that cannot be sustained and will inevitably lead to miscarriage.
It is possible for a miscarriage to occur naturally without the need for surgical intervention.
After a complete miscarriage, there are no contraindications to taking ovulation medications, and they can still be used.
Based on your medical history, a diagnosis of cervical incompetence cannot be made.

Reply Date: 2009/06/23

More Info

Cervical insufficiency and embryonic resorption are critical topics in obstetrics that can significantly impact pregnancy outcomes. Based on your previous experiences and current situation, it’s essential to understand both conditions and their implications for your health and future pregnancies.

Cervical Insufficiency: This condition occurs when the cervix is unable to support a pregnancy, leading to premature birth or miscarriage. It often presents without pain or significant symptoms, making it challenging to diagnose early. In your case, the tightening sensation and subsequent bleeding you experienced during your previous pregnancy could suggest cervical insufficiency, especially if the cervix was unable to maintain its integrity under the pressure of the growing fetus. The presence of a cervical polyp, as noted by your physician, may also contribute to bleeding but is less likely to be the primary cause of cervical insufficiency.

Embryonic Resorption: This term refers to the process where an embryo fails to develop properly and is absorbed by the body. It can occur due to various factors, including chromosomal abnormalities, hormonal imbalances, or issues with the uterine environment. In your recent pregnancy, the light line on the pregnancy test and the ongoing brown discharge could indicate that the embryo is not developing as expected, potentially leading to resorption. The fact that your doctor suggested the possibility of embryonic resorption based on your symptoms and the faint test line is concerning and indicates that the embryo may not be viable.

Regarding your questions about management and next steps:
1. Waiting for Miscarriage: If the doctor has indicated that the embryo may not be viable, you may indeed need to wait for a natural miscarriage. If the body does not expel the tissue naturally, a surgical procedure, such as a dilation and curettage (D&C), may be necessary to ensure that the uterus is cleared of any remaining tissue to prevent complications like infection or heavy bleeding.

2. Future Use of Ovulation Induction Medications: After a miscarriage or embryonic resorption, it’s generally advisable to wait for at least one normal menstrual cycle before trying to conceive again. This allows your body to recover and can help in accurately dating a future pregnancy. Discuss with your healthcare provider about the appropriate timing for resuming ovulation induction medications.

3. Implications of Early Bleeding: Early bleeding in pregnancy can be concerning, but it does not always indicate that the embryo is not healthy. Some women experience spotting or light bleeding, which can be normal, especially during implantation. However, in your case, the combination of early bleeding and the faint pregnancy test line suggests that close monitoring is essential.

4. Cervical Insufficiency Management: If cervical insufficiency is confirmed in future pregnancies, your doctor may recommend a cervical cerclage, a procedure where the cervix is stitched closed to prevent premature opening. This is typically done around 12-14 weeks of pregnancy.

5. Emotional Support: Experiencing a miscarriage or the threat of one can be emotionally taxing. It’s important to seek support from healthcare providers, counselors, or support groups to help you navigate these feelings.

In summary, while waiting for the outcome of your current situation, it’s crucial to maintain open communication with your healthcare provider. They can guide you through the next steps, whether that involves monitoring your current pregnancy or planning for future attempts. Understanding your body and its responses can empower you to make informed decisions moving forward.

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