Most people think all is clear after the end of the first trimester, but for about one in 100 women that may not be the case.
The American Pregnancy Association says that a condition known as incompetent cervix, or I.C., can lead to premature birth, miscarriage or loss. Most times, women don’t know they have it until they go into preterm labor or miscarry, which is what can make it so devastating.
Weak cervical tissue and pressure from the fetus can contribute to I.C., which is also known as insufficient cervix. The condition occurs when weak cervical tissue causes or contributes to premature birth or the loss of an otherwise healthy pregnancy.
Before pregnancy, your cervix is tightly closed. During pregnancy, it gradually softens and gets shorter before opening during dilation and the subsequent delivery. Women with I.C., however, experience their cervix opening too soon, resulting in early birth.
Having I.C. is a difficult issue because it can only be diagnosed during pregnancy — and it’s hard to know if you have it. The condition is typically diagnosed only after a miscarriage, when it's too late.
Knowing if you’re at risk for I.C. can help your doctor know whether or not to check for the condition throughout your pregnancy, and therefore be able to save your baby.
You might be at risk if you have had any tearing during a former delivery, or if you had a miscarriage during the second trimester. Women who have had a dilation and curettage, or D&C, procedure or have had previous surgery for an abnormal Pap smear (such as L.E.E.P. [loop electrosurgical excision procedure] or C.K.C. [cold knife conization]) that damaged the cervix might be at risk.
According to the Mayo Clinic, women should be on the lookout for pelvic pressure sensations, backaches, mild cramping, light vaginal bleeding and vaginal discharge changes.
If you have the condition and it can be detected in time, there’s hope to make sure it does not compromise your baby. A cerclage essentially sews the cervix shut and reinforces a weak cervix, and it’s performed around 14 to 16 weeks during pregnancy. Then, at 36 to 38 weeks, the sutures are removed to encourage natural labor.
There used to be risks to having — and not having — a cerclage, said Serena Chen, M.D., the director of the Division of Reproductive Endocrinology in the Department of Obstetrics and Gynecology at Saint Barnabas Medical Center.
"Now we can do repeated vaginal sonograms to check cervical length and that can be very helpful to doctors in figuring out who will really benefit from cerclage," she said.
Heather Huhman, a woman from the Washington, D.C. area, underwent an abdominal cerclage in April to prepare her body for future pregnancies. Just months before, she unexpectedly lost her twins because she did not know she had I.C. Since then, she started the Beat I.C. website as a means to inform others about the condition.
"Be your own advocate. You know your own body better than anyone. If you have one of the risk factors or warning signs, make sure your doctor takes your concerns seriously — or find another one who will," Huhman said.
She says that cerclages are quite controversial, so she recommends speaking with both pro-cerclage and anti-cerclage obstetricians. "I didn't know it at the time, but I had an anti-cerclage OB, so they told me only my options from that perspective," she said.
"Make sure you have all the information you need to make the best decision for you and your baby," she added.
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