Possible Incompetent Cervix

msteryn

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Reply Possible Incompetent Cervix Posted on: Jan 8, 2011 at 1:14am
First off, thank you for taking the time to listen and giving so many an opportunity to share and ask. Here's my story.

In 1997, I had an abnormal pap which resulted in me having to have a LEEP. No other abnormal paps since this procedure. At 25 I was diagnosed with mild Endometriosis and PCOS and was told that my husband and I would not be able to conceive with fertility drugs. We stopped using birth control and I had a positive pregnancy test at the end of the following month. Though we weren't trying to conceive, we were delighted. Unfortunately I miscarried at 11 weeks. I began having severe back pain which led to bleeding and so forth. Following a D&C I was told that the baby's intestines appeared to be external. I immediately began on birth control since I had only been married for 5 months at that point and we didn't want children so soon.
In February 2009, I ceased all birth control. We actively began trying in September 2009. I had a positive test on Oct. 7th, but miscarried on October 25th and light bleeding increased. I was told that this was likely a missed abortion since the ultrasound revealed an empty sac. Hubby and I waited a few months and I was pregnant again in March 2010. I miscarried for the 3rd time at 16 weeks, 4 days on June 14th 2010. On my way to the bathroom in the middle of the night, my water broke. For a few days prior to that, I felt some pressure, no pain, so I thought I could make it 5 more days until my follow-up appointment. I was wrong.

At the ER, my OB doc, who happened to be the doc. on call reported that I had begun to dialate. He wasn't sure if I dialated first or if my water broke first. The baby still had a healthy heartbeat, though the ultrasound revealed no fluid in the sac. My doc gave me medication to induce my labor. I delivered what doctors believed to be a healthy baby boy, and had a D&C afterwards. The doctor suggested that a loss this late might have been the result of an incompetent cervix. His plan was to insert a cerclage at about 15 weeks during my next pregnancy. I waited a few months and was pregnant for the 4th time at the end of September 2010. I began noticing a familiar pressure at 12 weeks and was able to convince my doc to insert the cerclage at 13 weeks. The surgery was a success. On December 17th, again at 16 weeks, I began having mild abdominal pain. On December 18th the pain increased and I noticed light spotting. I went to the ER and reported pain that felt like spasms in my cervix. An exam revealed that part of my amniotic sac was in the birth canal. An ultrasound revealed that my cervix was contracting with the McDonald's cerclage in place, thus the reason for the bleeding. I was immediately admitted. There were pictures taken during the ultrasound with an open and closed cervix. A portion of the sac was in the birth canal while the other was in my uterus. It was appeared much like a water balloon being squeezed. The baby was on the side in my uterus. Several doctors visited my room and gave me no hope of carrying this baby until 23 weeks, even on complete bedrest.

The next morning, a new doctor entered my hospital room and spoke of an emergency surgery to remove the cerclage. I laid there awake during the surgery since I was given a spinal. The surgeon reported that too much of the sac was in the birth canal to get around it to remove the cerclage. She then mentioned going in abdominally with a needle to remove some of the amniotic fluid in hopes that this would relieve some pressure from the sac and allow the portion that was outisde of my uterus to go back inside. An ultrasound in the OR revealed that all of the amniotic fluid in the sac was in the portion outside of my uterus. The next attempt was to manipulate my cervix and and attempt to manually push the sac back inside of my uterus. This continued in the OR until my sac broke. After that, I could predict the process. I was given medication to induce labor and eventually delivered another seemingly healthy baby boy at 16 weeks. The doctors sent the placenta to the lab for testing to confirm this but I haven't heard anything yet. Usually no news is good news.

My OB suggested that my LEEP may have caused an incompetent cervix or that I may not have an incompetent cervix at all since the 3rd pregnancy my water broke first and this pregnancy I began contracting prematurely. For the next pregnancy, he has recommended bedrest and an abdominal cerclage which would cause me to have to have a c-section. I'm not sure what to do since no one is sure about my case. Both my husband and I have had several tests. All have come back normal. I have had a history of bleeding during pregnancy. No one knows why and if this is related to my losses.

Please help! Any ideas or suggestions?

Dr. Braverman

2024 Posts
Re: Possible Incompetent Cervix Posted on: Jan 9, 2011 at 1:51pm
Hi Msteryn

Im very impressed with the care you recieved as it seems your group was on the cutting edge of dealing with such a difficult situation and I agree with their management and thought process here. Even the placement of the abdominal cerclage appears warranted.
It is alwasy a difficult diagnosis as to whether this is preterm labor or Inc cervix, but as you have he risk factor for inc cervic(LEEP) and you present at the same time I am most suspicous for this as well.
Activation by bacteria of TLR receptors (read in the website) can initiate labor and keeping the envirnment sterile early on may help with early vaginal cultures(being sure not to overtreat with antibiotics and not create a resistant strain). Usually however it is the contact of the membranes with the vaginal canal that allows the bacteria to get into the sac and then cause rupture of memebranes followed by bleeding and labor.
You should still have the immune and thrombophilia workup to be sure as they have suggested that it is not
labor that is occuring first , leading to the cervix dilating and not just a week cervix.
Feel free to call me if you would like me to help you with any testing. I hope I can be of service to you.
Dr. Jeffrey Braverman MD FACOG
Medical Director
Braverman Reproductive Immunology P.C.

msteryn

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Reply Re: Possible Incompetent Cervix Posted on: Jan 10, 2011 at 3:38am
Dr. Braverman,

Thank you so much for your prompt response. I would certainly like to contact to for more details about the tests I should have. Also, you mention having cultures done early in pregnancy. I'd like to hear more. I look forward to your next reply.

Dr. Braverman

2024 Posts
Re: Possible Incompetent Cervix Posted on: Jan 10, 2011 at 5:17am
I would perform monthly vaginal cultures and treat any excess bacterial growth, again being careful not to overtreat and cause a resistant strain, this would have to be carried out by knowledgeable physicians and it sounds like your team is.
Dr. Jeffrey Braverman MD FACOG
Medical Director
Braverman Reproductive Immunology P.C.