QuestionHello and thank you so much for what you do!
So this is my 4th pregnancy (births in 5/03, 8/05, 1/07). I have had multiple bouts of medicated/treated preterm labor with my first 3 girls but delivered each at 39wk. Surgery(10/07) to remove ruptured tubal, IUD, and cysts. I am 24.5 weeks pregnant and starting to show cervical changes. At 20 wks cervix was long hard and not dialated. 2 weeks ago I had a loss of mucus(no blood). Last week cervix measured 3cm long, 1cm dilated on outside/closed inside, still firm. Now I am 2cm dilated on outside/closed inside, mostly softened, one side of the cervix is as short in length as a third of a fingertip and the other side is about a fingertip and a half. My midwife is so naturally minded she tells me not to worry but I am alarmed at this early change. I am onlyin my second trimester. Should I be concerned? Is this normal? Should I seek a second opinion? And how urgently. Thank you so much!
AnswerDear Alicia,
The pressure as the baby grows into the 2nd and 3rd trimesters may cause the cervix to start to open before the baby is ready to be born. This condition is called an incompetent cervix or weakened cervix, and it can sometimes lead to a miscarriage or premature delivery. An incompetent cervix happens in only about 1 out of 100 pregnancies.
The use of ultrasonography has been very helpful with the diagnosis, and is made when the cervical os (opening) is greater than 2.5 cm, or the length has shortened to less than 20 mm. (Sometimes funneling is also seen, this is where the internal portion of the cervix, internal os (portion of the cervix closer to the baby) has begun to efface. The external os will be unaffected if diagnosed in time.)
A weakened cervix can be caused by one or more of the following conditions:
-Previous surgery on the cervix
-Damage during a difficult birth or multiple births
-Malformed cervix or uterus from a birth defect
-Previous trauma to the cervix, such as a D&C (dilation and curettage) from a termination or a miscarriage
-DES (Diethylstilbestrol) exposure
Often the treatment for an incompetent or weakened cervix is a procedure that sews the cervix closed to reinforce the weak cervix. This procedure is called a cerclage and is usually performed between week 14-16 of pregnancy. These sutures are then removed around the 36-37th week to prevent any problems when you go into labor. Removal of the cerclage does not result in spontaneous delivery of the baby. A woman would not be eligible for a cerclage if:
-There is increased irritation of the cervix
-The cervix has dilated to 4cm
-Membranes have ruptured
At this point, your cervical dilatation sounds manageable by your midwife. I would suspect she may be recommending reduced physical activity (especially no lifting) and possibly pelvic rest as well. But if not, she may well do that if your cervix continues to dilate/efface. However - by all means, if it makes you feel better or more reassured, never hesitate to get a 2nd opinion.
I hope this has helped you and answered your question. I wish you well.
Brenda
