Short Cervix During Pregnancy: Risks and Management

Short cervix

Hello, Doctor.
I am currently almost eighteen weeks pregnant with my first child.
During an abdominal ultrasound at eleven weeks, the doctor informed me that my cervical length was less than 3 cm, which was considered dangerous (this check-up was done in Japan).
The doctor advised me to return to Taiwan quickly, as I might not be allowed to travel back if the length decreased further.
So, I returned shortly after.
At sixteen weeks, I went to Dr.
Ke Congming for an amniocentesis, and I asked him to measure my cervical length via transvaginal ultrasound.
The result was within the normal range, with the longest measurement being 4 cm.
I thought I could finally stop lying down (I had been lying down for over a month).
The doctor said I could start walking again and advised me not to lie down too much, as it could lead to depression.
I have indeed been feeling quite depressed.
A few days later, I noticed some watery discharge and went to the clinic for a check-up.
Because I was still anxious about my cervical length, I asked the doctor to perform a cervical exam.
The longest measurement was only 3 cm, and I was surprised that it had shortened so quickly! I wonder if there might be differences in measurement techniques used by the doctors.

I started feeling anxious again, and the doctor suggested that I go to the hospital to see if a doctor could perform a cervical cerclage.
The next day, I went to Chang Gung Hospital, where they only performed an abdominal ultrasound and measured my cervical length at 2.2 cm.
They mentioned that they would only take action if it dropped below 1.5 cm, and that anything over 2 cm is not considered short.
About ten years ago, I underwent a cauterization procedure due to cervical dysplasia.
Could this surgery have contributed to my cervical shortening? I am quite hesitant to go out and try to lie down as much as possible; otherwise, I sit half-reclined.
I am really scared that my baby might come out, which is making me very anxious.

I would like to ask for your advice, please.
Would it be safer to have a cervical cerclage given my current length? Since this is my first pregnancy and I am of advanced maternal age, all of these uncertainties are making me extremely anxious.
I hope you can provide me with some guidance.
Thank you very much!

Aya, 30~39 year old female. Ask Date: 2015/09/17

Dr. Lü Lizheng reply Obstetrics and Gynecology

1.
Indeed, pregnant women with a shorter cervical length are more likely to experience preterm birth.
However, this is only a possibility and does not guarantee that preterm birth will occur.

2.
According to research conducted by international scholars, the average cervical length for pregnant women in the second trimester is approximately 3.5 cm, with 10% of women having a shorter length of 2.5 cm, and 5% having an even shorter length of 2.0 cm.
One study observed a group of women at 24 weeks gestation with a cervical length of 25 mm, and found that 18% of them delivered preterm before 35 weeks.
Another group of women with a cervical length of 13 mm at 24 weeks had a 50% preterm delivery rate before 35 weeks.

3.
Therefore, it is advisable to analyze whether there are other potential risk factors for preterm birth.
For instance, if there is a history of very early preterm birth or a history of cervical conization, the combination of these factors with a shorter cervical length significantly increases the likelihood of preterm birth.
In such cases, a cervical cerclage procedure may be recommended to strengthen cervical integrity and reduce the risk of preterm birth.
As for the cervical cauterization you mentioned, it is generally not considered a risk factor.
4.
Other potential causes for cervical shortening that may lead to preterm birth include chronic intrauterine inflammation, chronic placental bleeding, and excessive intrauterine pressure.
It is recommended to evaluate whether these preterm birth causes are present.
5.
Measuring cervical length can also be prone to errors; therefore, a transvaginal ultrasound is recommended for more accurate assessment.
Follow-up measurements can be taken every one to two weeks to observe trends in cervical length changes.
If the length continues to shorten, intervention may be necessary.
6.
In addition to measuring cervical length, some practitioners perform a digital examination to assess the softness and thickness of the cervix.
If the cervix is very soft and thin, it may be less favorable, and active management is advised.
Pregnant women can also be asked to hold their breath and bear down to test for cervical protrusion; those with insufficient cervical strength are more likely to show protrusion and should be managed with caution.
7.
If there are no other risk factors for preterm birth and the only concern is a shorter cervical length, whether intervention is necessary remains a topic of debate.
Generally, it is believed that the shorter the cervix, the more aggressive the management should be.
What constitutes "short" varies among practitioners; some may intervene when the cervical length reaches 10 mm, while others may take action at 25 mm.
8.
The approach to management also varies by individual.
Typically, physicians will first consider progesterone treatment while monitoring the situation, and if it worsens, they may proceed with cervical cerclage.
Some physicians may opt for immediate surgical intervention.
Additionally, it is generally advised to refrain from sexual intercourse and to avoid activities that increase abdominal pressure, such as lifting heavy objects or mopping.

Respectfully,
Dr.
Li-Cheng Lu, Taoyuan Hospital

Reply Date: 2015/09/17

More Info

Understanding a short cervix during pregnancy is crucial, especially for first-time mothers or those who are older. A short cervix, defined as a cervical length of less than 2.5 cm, can increase the risk of preterm birth and other complications. In your case, the fluctuation in measurements—from 4 cm to 2.2 cm—can understandably cause anxiety. It is important to recognize that cervical length can vary based on the method of measurement (transabdominal vs. transvaginal ultrasound) and the time of day or your level of activity.

The concern about your cervical length is valid, especially since you have a history of cervical surgery, which can indeed affect cervical integrity. Surgical procedures like conization or LEEP (Loop Electrosurgical Excision Procedure) can lead to cervical shortening, which may increase the risk of complications in pregnancy. However, not all women with a history of cervical surgery will experience issues during pregnancy, and many go on to have healthy pregnancies.

Given your situation, here are some recommendations and insights:
1. Regular Monitoring: Continue to have regular ultrasounds to monitor your cervical length. This is crucial in assessing any changes and determining the best course of action. If your cervical length decreases significantly, your healthcare provider may recommend interventions.

2. Cervical Cerclage: If your cervical length drops below 2.5 cm, especially if it approaches 1.5 cm, your doctor may discuss the option of a cervical cerclage. This is a surgical procedure where the cervix is stitched closed to help support it during pregnancy. It is typically performed in the second trimester and can be beneficial for women with a history of cervical insufficiency.

3. Activity Modification: While your doctor has advised that you can start walking again, it's essential to listen to your body. If you feel discomfort or increased pressure, consider reducing your activity level. Bed rest is not always necessary, but limiting strenuous activities can help.

4. Emotional Support: The anxiety and stress you are experiencing are common among pregnant women, especially those with complications. Consider seeking support from a mental health professional or joining a support group for pregnant women facing similar challenges. This can help alleviate feelings of isolation and anxiety.

5. Communication with Your Healthcare Provider: Keep an open line of communication with your healthcare team. If you have concerns about your cervical length or any symptoms you experience, do not hesitate to reach out. They can provide reassurance and adjust your care plan as needed.

6. Education: Educate yourself about cervical insufficiency and preterm labor. Understanding the signs and symptoms can empower you to seek help promptly if needed. Resources from reputable organizations like the American College of Obstetricians and Gynecologists (ACOG) can provide valuable information.

In summary, while a short cervix can pose risks during pregnancy, proactive monitoring and appropriate interventions can significantly improve outcomes. Your healthcare provider will guide you through this process, and it’s essential to remain vigilant and informed. Remember, every pregnancy is unique, and many women with a short cervix go on to have healthy pregnancies and deliveries. Stay positive and take care of yourself both physically and emotionally.

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