Incompetent cervix

The term "incompetent cervix" is awful. What it means is that the cervix opens prematurely in pregnancy, often leading to miscarriage. If it happens in one pregnancy, it is very likely to happen again as it is usually caused by a genetic abnormality. Women whose mothers took DES are likely to have this problem.

It is uncommon but if it happens to you, it is heart-breaking.

The good news for those of us who have had a LEEP or cone biopsy due to dysplasia or cervical cancer is that we are not doomed to suffer from this. When premature opening occurs, it does so from the inside out, like a funnel. If you won the genetic lottery and have a long cervix, you'll probably be fine, even after losing some of the external cervix to surgery.

The key is to know that it could happen and get monitored early. The length of the cervix is not routinely checked in pregnancy. Only after a woman suffers a second or third trimester miscarriage do the doctors check the cervix in subsequent pregnancies.

But women who have had cervical surgeries are considered to be a high-risk pregnancy and are usually referred to the perinatologist early or even before pregnancy.

Once you're pregnant, what the perinatologist will do is check the cervix with ultrasound, both vaginally and abdominally. The doctor can measure the length and monitor it as the pregnancy progresses. If changes occur, an early cerclage can be placed in the cervix and help keep the baby inside.

The cerclage is done through the vagina, so you're awake for it, but the doctor will numb the cervix. Then the doctor puts in a suture that will stay there until a couple weeks before delivery.

It's very important to go see a specialist during your pregnancy because if your cervix does start to open prematurely, you won't feel it happening.

Trachelectomy cerclage

Women who have a trachelectomy procedure have a special cerclage placed before pregnancy called a Shirodkar cerclage. It's a bit more intensive. It is put in through the abdomen rather than through the vagina, and it's usually done at the same time as the trachelectomy. Once it's there, it's permanent, replacing the function of the cervix.

Unfortunately, I can't tell you that it's as good as a cervix in keeping a baby inside. Studies have shown that women post-trachelectomy have a higher likelihood of preterm labor and miscarriage. This points to the need to find a good obstetrician who has experience with high-risk pregnancies and patients with an incompetent cervix.