Q. I have been diagnosed with a small cervix and I am currently about 22 weeks pregnant. I wonder if I may run into problems with losing my child if I don't have the cerclage placed on my cervix. What are the risks?
A. Cervical incompetence can occur from cervical cancer, surgical procedures (such as a cone biopsy) or by a small cervix. A short cervical canal or small cervix may dilate without contraction in mid-pregnancy, causing pregnancy loss. Depending on the extent of your condition, your doctor will probably recommend bed rest or the cervical cerclage. The cerclage is performed by stitching your cervix shut with a very strong thread to keep it closed until the fetus is fully developed.
The risks of developing an incompetent cervix may outweigh the risks associated with having the cerclage procedure. In a small percentage of cases, risks of the cervical cerclage might include:
- Premature labor
- Infection of the cervix
- Tearing or opening the cervix if you go into labor with the cerclage in place
Most OB/GYNs will remove the cerclage at 37 weeks, well before you go into labor. The procedure is about 85% to 90% successful.
Q. I am five months pregnant and had a cervical cerclage. My doctor said not to have sexual intercourse. Does this include masturbation?
A. I think the cervical cerclage is a terrific invention of modern medicine, allowing women with cervical incompetence problems to carry a pregnancy to term. The risks of having the procedure include possible tearing and damage to the cervix if the uterus contracts too strongly or if dilation begins. Intercourse and, I'm sorry to say, masturbation may cause your uterus to contract, especially if you orgasm. Later in pregnancy, uterine contractions from orgasm become even stronger still and may pose a serious threat to the stitches of the cerclage. The good news is, since you are already at five months, you're more that halfway to your delivery date. Hang in there!
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Q. I had a cervical cerclage at 22 weeks. I'm now 34 1/2 weeks pregnant. What are the risks of the stitch tearing the cervix if labor starts before the stitch gets taken out at 36 1/2 weeks? I'm concerned about the baby. The nearest NICU is one hour away.
A. If labor does start before the cervical cerclage is removed, you may be at risk for cervical tearing and/or laceration. If you notice any pending signs of labor, such as the breakage of water or labor-like contractions, you should get yourself to your OB/GYN or emergency room to prevent this from happening. You may be given a drug to stop the progression of labor, or if you are at 36 weeks or more, your doctor may remove the cerclage to allow labor and delivery to follow. In either case, the risks to your baby with this procedure are minimal. In most cases, the benefits associated with having a cervical cerclage (primarily to the mother) greatly outweigh the risks. This life-saving procedure is usually 85 to 90% successful.
Q. I am 22 weeks pregnant. My cervix is 1.8 mm long, and I am on bed rest. What are my chances of having this baby?
-Anonymous, New York
A. Normally, if your cervix gets below 2.5 centimeters before 20 weeks, your doctor will do a cervical cerclage to keep your cervix from opening prematurely. After 20 weeks, a cerclage is too risky unless it becomes an emergency situation and bed rest is usually the recommended treatment. I cannot tell you what your exact chances are for having the baby, but I can tell you that if you follow your doctor’s orders closely, you will be giving your baby the best chance for a healthy development and delivery. Hang in there. Every day your baby stays in utero, his or her chances for normal development increase.
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Q. What are the procedures to remove the cervical cerclage? I'm 14.4 weeks and I just had mine done. Does taking the cerclage out hurt more than having it put in?
A. Although I cannot give you an opinion based on personal experience, I will tell you that I've heard (from numerous sources) that removal of a cervical cerclage is much less uncomfortable than having the stitches put in. Most stitches are removed in the doctor's office without any problems. The procedure feels similar to having a pap smear and may cause some light bleeding.
Q. I am a 30-year-old pregnant woman (19 weeks) with diabetes and I was recently told that I may end up having a cervical cerclage performed (I'm down to 2.7 cm right now). How important is bed rest after this procedure is performed? Is there anything I can do instead? Are there any other alternatives to this procedure? I have to work and attend school at night for financial reasons.
A. Normally, if your cervix gets below 2.5 centimeters before 20 weeks, your OB/GYN will employ a cervical cerclage to keep your cervix from opening prematurely. If your doctor recommends it, I think you should have the procedure. The benefits greatly outweigh the risks of having a cervical cerclage. (See the other cervical cerclage questions for more details.)
After the procedure, you may be briefly hospitalized (24 hours or less) or you may be told to take a day or two of bed rest to ensure you have no excessive bleeding or cramping. The alternative to having the cervical cerclage is to go on complete bed rest for the duration of the pregnancy, or you may be putting yourself at high risk for miscarriage.
Q. I'm 37.4 weeks pregnant and had my cerclage taken off three days ago. All went well. I just had light bleeding that has disappeared now. I was too embarrassed to ask my doctor if I can now have sex or stimulation. He did say I was 3 cm dilated, but I am not having contractions. Can having sex help bring on labor? Would it be okay to have sex?
A. Sex may induce contractions, which could lead to active labor. If you're ready to have this baby now, I'd say go ahead and have sex. At this stage of pregnancy, the baby should be fully developed and ready enough to be born. I think your doctor would have warned you not to have intercourse if there was any reason for it.