In Part 1, the reader learned Cervical Insufficiency is a weakness of the cervix that sometimes requires a Cerclage. However, do all women with cervical lengths less than 25 mm require a cerclage? If a “short” cervix is found by coincidence during a routine ultrasound, should a cerclage be ordered? The answers to both questions are “no.” A woman with a cervical length of less than 25 mm but greater than 15 mm is not a candidate for a cerclage if she’s had no symptoms of preterm labor or history of previous premature birth. Although twin pregnancy is a risk factor for premature birth, cerclage placement is not recommended. For reasons presently unknown, a cerclage significantly increases the risk of preterm birth in twin pregnancies.
The cervix normally begins to shorten and become thin at 32 to 34 weeks and it is not uncommon to see measurements of less than 25 mm at that time. However women with a previous history of preterm birth should be followed by ultrasounds for cervical length measurements beginning at 15 to 16 weeks and continued every two weeks until they reach 26 to 28 weeks. If the cervical length is between 16 mm to 25 mm before 23 weeks, progesterone injections or suppositories are also suggested.
It is recommended that women with cerclages make lifestyle changes in order to prolong their pregnancy. Sexual intimacy, standing for greater than 4 hours a day, lifting greater than 20 lbs or straining, weight training exercises, impact aerobics and activities that produce pelvic pressure or discomfort should be avoided.
When should a cerclage be removed and should it only be removed when the patient has spontaneous labor? Medical studies indicate that only 11 % of women develop spontaneous labor 48 hours after a cerclage removal. Cerclage removal before the onset of labor is highly recommended to avoid bleeding, infection or a cervical tear. The average length of time of delivery after cerclage removal is 14 days, with one exception. Women who had a cerclage placed because of an ultrasound finding are 5 times more likely to deliver within 48-hours after it is removed. Does the cerlage have to be removed in a hospital setting? No according to a study cited in the American Journal of Obstetrics & Gynecology provided the patient is without symptoms of impending labor. A cerclage may be removed in an office setting.
A heightened awareness regarding cervical insufficiency can prevent undesired preterm complications. Do you know how to anticipate the unexpected events that could occur during your pregnancy? You will if you purchase The Smart Mother’s Guide to a Better Pregnancy available on Amazon.com or wherever books are sold.