If I Could Create an Incompetent Cervix Study

If I could spearhead a study about incompetent cervix, this is how I would want it to work...

The would include women who had experiences the birth and/or loss of a baby between fifteen weeks and thirty weeks gestation. The previous births would be attributed to preterm labor, premature rupture of the membranes, incompetent cervix, or unknown causes with or without infection. Women joining the study should be in their first trimester. Ideally, they would begin between week six and week eight. An equal control group of women who have not had pregnancy complications should be included, as well.

Each mother would have a full work up and history to confirm the presence or absence of known risk factors for incompetent cervix, such as DES exposure, cervical trauma such as a D&C (dilation and curettage) from a termination or a miscarriage, previous surgery on the cervix, including biopsies, damage during a difficult birth, congenitally short cervix, malformed cervix or uterus from a birth defect, and uterine anomalies.

On a weekly basis during the entire pregnancy the mothers would have blood panels done to check hormone levels such as testosterone, estrogen, and especially progesterone. Blood testing should also include a full CBC with differential and platelet workup, antinuclear antibodies, and a complete metabolic panel.

Weekly pelvic ultrasounds would be performed to watch for funneling or shortening of the cervix. If funneling or shortening is observed the mother will receive a cerclage to increase the chances of a successful pregnancy. Any mother who has already been diagnosed with incompetent cervix will receive a cerclage at thirteen to fourteen weeks gestation.

I would be interested to see the statistics regarding the success rates of emergency cerclages when placed at the first sign of trouble. Emergency cerclages have been reported to have a low success rate. In talking with other women who have incompetent cervix I have found that most who were able to get an emergency cerclage were initially refused a cerclage, did not get a cerclage for many days, or received them after the cervix was open, often with membranes protruding into the vagina. Preventative cerclages have much higher success rates because they are placed before changes in the cervix occur. I believe that if doctors could catch cases of incompetent cervix during the period prior to the cervix actually opening, that emergency cerclages might be just as effective as preventative cerclages.

In cases where premature rupture of the membranes does occur, I would like the women put on full bed-rest with intravenous antibiotics to prevent infection. I do not want ruptured membranes to immediately result in the delivery of the baby if that can be prevented. Medication to stop contractions, such as brethine or magnesium sulfate, should be used if needed. The mother should be closely monitored for any signs of infection.

It would be wonderful if we could identify women who are at risk for incompetent cervix. They could be considered high risk, which would allow for closer monitoring during pregnancy. Weekly ultrasounds between sixteen and twenty-four weeks gestation would probably prevent the loss of many if not most losses due to incompetent cervix since it would allow for early detection of cervical incompetence and the ability to receive an emergency cerclage. These are not always successful, but the earlier you get one, the more likely it is to be successful. Discovering which, if any, hormone irregularities might be a contributing factor would be invaluable. If the simple act of taking a progesterone supplement could reduce the risk of developing incompetent cervix, it would just be phenomenal.

I really think there are a lot more cases of incompetent cervix than statistically reported. It's just so hard to diagnose it after the fact. You generally have to "catch it in the act" before you can make a definitive diagnosis. If you don't it's impossible to tell if you went into labor because you were dilating or you dilated, resulting in you going into labor. How can incompetent cervix be prevented if it can't be identified?

I'd also like to see a standard practice for dealing with incompetent cervix. It seems to me that the vast majority of doctors practically refuse to treat the condition. I've seen so many women lose their babies when their doctors simply refused to even consider the use of a cerclage. I just think that is totally unacceptable. Mother's are putting the lives of their babies in the hands of practitioners who are not willing to do everything in their power to give their babies the chance to live.

Well, that's my moment of dreaming for this morning.