Concerns During Pregnancy: Cervical Insufficiency and Cerclage Surgery

Q: Concerns During Pregnancy: Cervical Insufficiency and Cerclage Surgery

A. <br>Regarding cervical length and preterm birth： 1. <br>Transvaginal ultrasound is more accurate for measuring cervical length. <br>2. <br>The optimal time for measurement is between 18 to 24 weeks of pregnancy; a cervical length of less than 2.5 cm is associated with a 10-20%

Concerns during pregnancy: cervical incompetence and cervical cerclage?

Hello Dr.
Liu,
Several years ago, I underwent five artificial abortions (dilation and curettage), three of which were due to embryonic demise with no heartbeat.
Subsequent examinations, including chromosomal analysis for both my partner and me, as well as autoimmune tests, all returned normal results.
Over five years ago, I became pregnant again, and everything was normal; I delivered naturally at 39 weeks and 6 days.
However, the doctor mentioned that my first labor was quite rapid, progressing from contractions to 4 cm dilation in just 4-5 hours, with a total labor duration of over 7 hours, which was noted as not ideal.
Two years later, I became pregnant again.
Initially, I experienced some bleeding, but after taking bed rest and medication for a week or two, things improved.
However, at 16 weeks, while straining during a bowel movement, I suddenly experienced a strong gush of fluid from my vagina, which shocked me.
Upon going to the hospital, I was informed that there was no amniotic fluid left, and the membranes had ruptured, with the fetal legs visible.
Unfortunately, the pregnancy could not be saved, and I had to undergo induction.
Desiring to have another child, I sought medical advice again.
Some doctors suggested that the issue might be due to an infection or cervical incompetence.
Later, I was diagnosed with a uterine septum.
In August 2010, I underwent a surgical procedure to remove part of the septum, but the doctor later indicated that the excised area was minimal and could still lead to suboptimal uterine cavity conditions.
Ultimately, I had another surgery for this issue in mid-October last year, and the recovery has been good, with the wound and space appearing satisfactory.
I am currently 12 weeks pregnant and feeling well, but I am concerned about the possibility of early rupture of membranes again.
A few days ago, my doctor measured my cervical length at 3.5 cm, but noted that the cervix is slightly open.
I would appreciate any advice you could provide.
If I were to undergo a cervical cerclage, would spinal (epidural) anesthesia be preferable? What are the differences compared to general anesthesia? I am worried that anesthesia might affect the fetus.
What is the common form of anesthesia used in such cases?
Could you recommend any doctors in Yunlin, Chiayi, or Changhua who are familiar with my situation? I have so many concerns and questions, and I sincerely apologize for burdening you with them.
I hope you can assist me! Thank you very much!
Lastly, I wish you and your family peace, health, and happiness.

nancy, 30~39 year old female. Ask Date: 2012/05/05

Dr. Liu Yuhong reply Obstetrics and Gynecology

A.
Regarding cervical length and preterm birth: 1.
Transvaginal ultrasound is more accurate for measuring cervical length.
2.
The optimal time for measurement is between 18 to 24 weeks of pregnancy; a cervical length of less than 2.5 cm is associated with a 10-20% risk of preterm birth.
3.
Measurements of cervical length before 15 weeks of pregnancy cannot predict the risk of preterm birth.
Therefore, based on your situation, Ms.
Nancy, there is no need to be concerned about cervical length at this time (12 weeks pregnant).
B.
Regarding cervical cerclage surgery, current medical research does not indicate whether spinal anesthesia or general anesthesia is superior.
The choice of anesthesia depends on the anesthesiologist's decision, and both types are commonly used.
If one must compare the two, the concern with spinal anesthesia is hypotension, while the concern with general anesthesia is aspiration pneumonia.
Anesthesia typically does not affect the fetus; both personal and departmental experiences have not reported maternal or fetal complications related to anesthesia during cervical cerclage surgery.
In summary, the anesthesia used for cervical cerclage surgery is considered to have a high safety profile.
C.
I apologize, but I am not familiar with physicians in the Yunlin and Chiayi areas and cannot provide recommendations.
Wishing you a smooth pregnancy and a healthy baby.

Reply Date: 2012/05/05

More Info

It sounds like you have been through a lot in your journey toward pregnancy, and it's completely understandable to have concerns, especially given your history of miscarriages and cervical issues. Let's break down your situation and address your questions regarding cervical insufficiency, cerclage surgery, and the associated risks.

Cervical insufficiency is a condition where the cervix begins to open too early during pregnancy, which can lead to premature birth or miscarriage. Given your history of multiple pregnancies with complications, it is wise to be vigilant about your cervical health. The fact that your cervical length is currently measured at 3.5 cm is a positive sign, as a cervical length of more than 2.5 cm is generally considered reassuring. However, the fact that your cervix is slightly open does warrant close monitoring.

Cerclage is a surgical procedure where a stitch is placed around the cervix to help keep it closed during pregnancy. This procedure is often recommended for women with a history of cervical insufficiency or those who have had second-trimester losses due to cervical incompetence. The timing of the cerclage is crucial; it is typically performed between 12 and 14 weeks of gestation. Given your current pregnancy at 12 weeks, discussing the option of cerclage with your healthcare provider is essential.

Regarding anesthesia, cerclage can be performed under either spinal (epidural) or general anesthesia. Spinal anesthesia is often preferred for this type of procedure because it allows for a quicker recovery and less impact on the mother and fetus compared to general anesthesia. General anesthesia can carry more risks, including potential effects on the fetus, so it is usually reserved for cases where spinal anesthesia is not feasible. Your healthcare provider will discuss the best option for you based on your medical history and the specifics of your case.

It is also important to address your concerns about the potential for early rupture of membranes (PROM). While cerclage can help prevent cervical dilation, it does not eliminate the risk of PROM entirely. Close monitoring of your pregnancy, including regular ultrasounds and cervical length assessments, will be crucial. If you experience any signs of labor, such as contractions or unusual discharge, it is vital to seek medical attention immediately.

In terms of finding a specialist, I recommend looking for a maternal-fetal medicine (MFM) specialist or a high-risk obstetrician in your area. These professionals are trained to handle complex pregnancies and can provide the care and monitoring you need. You can ask your current healthcare provider for referrals or check with local hospitals that have specialized maternal-fetal medicine departments.

Lastly, it’s essential to maintain open communication with your healthcare team. Share your concerns and ask questions; they are there to help you navigate this journey. Remember that you are not alone, and many women have successfully carried pregnancies to term after experiencing similar challenges.

Wishing you a healthy pregnancy and the best of luck as you move forward. Take care of yourself, and don’t hesitate to reach out for support when you need it.

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