LIFE by Dr. Pat
LIFE by Dr. Pat
Cervical incompetence
One more thing to watch for after a congenital uterine anomaly is repaired
If you were born with an abnormally shaped uterus, having it surgically corrected and getting pregnant is not the end of the story. There is one more thing we keep an eye on: cervical incompetence.
Who needs watching
Women with a congenital uterine anomaly, whether that is:
- A dysmorphic uterus
- A uterine septum (septate uterus)
The body of the uterus and the cervix grow from the same embryonic structure — the Müllerian ducts. So a woman with a uterine anomaly may well have had an abnormal cervix from the very beginning too.
What it feels like
Most women with cervical incompetence feel nothing at all. Some notice only a little vaginal bleeding while the cervix quietly thins and slowly opens — and typically they never feel the uterus contracting.
- Trouble usually starts at 18–20 weeks of pregnancy
- And it can come back at 32–34 weeks
The catch
By the time the contractions hurt, the cervix is already more than 5 cm dilated — and miscarriage or very preterm birth can follow within minutes of the first symptom.
Prevention and follow-up
There are several ways to manage this. What I recommend for prevention is measuring cervical length by ultrasound at least three times, at:
- 11–12 weeks
- 18–20 weeks
- 27–28 weeks
These are the points in pregnancy when the uterus changes and a shortening cervix may show up — and when a cervical cerclage or pessary can be placed to keep the cervix from shortening and opening.
May you all have a beautiful baby, a safe pregnancy and an easy birth.