Key Notes On Cervical Incompetence


Key Notes On Cervical Incompetence
Management Of Cervical Incompetence
Treatments & Drugs
Cervical incompetence is a relatively common occurrence in some women  and also a notorious cause of  pregnancy.
There are various treatments protocols  for  managing an incompetent cervix these include:
1 ■ Progesterone supplementation.
Progesterone is a very important hormone involved in pregnancy.  Most women with  history of premature birth might benefit from this treatment. This might be  weekly shots of a form of the hormone progesterone called hydroxyprogesterone caproate (Makena) during your second trimester. 
Currently researchers are reviewing  cases to determine the best use of progesterone in cervical insufficiency.
From  current evidence , progesterone treatments don’t seem to be helpful for pregnancy with twins or more.
2■ Use of Serial ultrasounds. 
This is highly indicated If you have a history of early premature birth, or you have had cervical damage in previous deliveries or operations.
This is used as a kind of surveillance, and  might begin with  carefully monitoring the length of your cervix by giving you ultrasounds every two weeks from week 15 through week 24 of pregnancy.
In the event your cervix   begins to open or becomes shorter than a certain length, your health care provider might recommend cervical cerclage at that point. 
3 ■ Cervical cerclage
Finally , this surgical procedures  is indicated if you are less than 24 weeks pregnant or have a history of early premature birth and an ultrasound shows that your cervix is opening.
Cervical cerclage might help prevent premature birth. During this procedure, the cervix is stitched closed with strong sutures. The sutures will be removed during the last month of pregnancy or during labor. This can be intra abdominal procedure or via the vagina.
■Please note, if you have a history of premature births due to  likely  cervical insufficiency, your doctor might also recommend cervical cerclage before your cervix begins to open (prophylactic cerclage). This procedure is typically done before week 14 of pregnancy. Be mindful that cervical cerclage is not  appropriate for everyone at risk of premature birth, however.
■ For example, the procedure isn’t recommended for women carrying twins or more. Be sure to talk to your doctor about the risks and benefits of cervical cerclage.
4■ Use of Vaginal Pessary
Where available ,your doctor might also recommend this device which fits into the vagina  and is designed to hold the uterus in place . The pessary can be used to help reduce  pressure on the cervix.
Please note, the choice of management  will be based on individual history and previous  experiences.
Further research is ongoing in best practices in management of cervical insufficiency.
Thank you.
Chudi Ufondu. MD
Reference & Photo Credit
Mayo Clinic
Medindia
#TeamAsktheGynaecologist