Q. Last week I started to spot for about one hour. My doctor said my cervix was bleeding, red and irritated. He did an ultrasound to make sure it was not coming from the uterus and he was pretty sure it was from the cervix. The ultrasound also showed that the placenta is about an inch away from my cervix. I am scheduled for another ultrasound next week when I’ll be in my 18th week of pregnancy. Will this problem cause my cervix to become incompetent and lead to more problems in the future?
A. It sounds as if you have placenta previa, where the placenta touches, covers or partially covers the cervix. Experiencing bleeding and having an irritated cervix are very common with placenta previa. (See the other placenta previa questions for more details.)
Since you are less than halfway through your pregnancy and the placenta is already an inch away from the cervix, you have a very good chance for the placenta to move up and away from the cervix completely. And, having placenta previa does not mean that your cervix is incompetent. These two conditions are unrelated. With proper prenatal care, about 99 percent of women with placenta previa deliver perfectly normal, healthy babies.
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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.
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Q. I lost a baby at 23 weeks nine years ago. The cause was uncertain, but questions arose about whether my cervix could have been incompetent. Now that I am pregnant again, could my cervix have healed? Nine years later, would a cerclage be necessary?
-Anonymous, New York
A. If your cervix was incompetent previously, it could be incompetent again. I don't think this condition heals over time. Do be sure to inform your current OB/GYN of your prior miscarriage and the possibility of an incompetent cervix. After examining you, your doctor may or may not recommend a cervical cerclage. (See other cervical cerclage questions for more details.) Just being aware of your previous condition gives you the best chance for carrying a normal, healthy baby to term.
Q. I'm currently six weeks pregnant, have had one previous miscarriage at four weeks, and two healthy children. I have been checking my cervix for the last nine months and know it pretty well. During my miscarriage I noticed it was really open through the entire time I was miscarrying. With this pregnancy I noticed it was closed in the beginning and now it's slightly open. After two vaginal births will my cervix never fully close and always feel slightly open? My cervix also feels hard and low. At my first doctor's appointment, he said my cervix was "a little blue."
A. After even one vaginal birth, the cervix will never fully close as it once did. The cervix takes on a "multiparous" look. That can only be described as a fish-like mouth. However, this does not occur if you've had a C-section.
For your stage of a third pregnancy, I think your cervix is behaving normally. (See the other "cervical changes" question for more details.)