• Dr Peter Chew

“My cervix was sewed shut!”

S and her husband were devastated. She had just miscarried. She was hoping that things would go well in her pregnancy. At five months of gestation, she suddenly felt the water bag burst with a gush of “water” running down her legs. Without any warning of abdominal cramps or pain, the baby just slipped out of her within minutes. All these happened so fast that she did not even have time to call her husband who was working.

This was S’s second pregnancy. Her first pregnancy was terminated at 10 weeks gestation when she was a teenager many years ago. There was lack of support from her boyfriend and her family then. When S was married a year ago, she did not waste any time trying to conceive. She was overjoyed when she realised she was pregnant a month after her marriage. However, her excitement was short-lived.

S has cervical incompetence or cervical insufficiency, a condition in which the muscle fibres of the cervix (neck of the womb) are weak. In a normal pregnancy, the cervix is close and firm. It would hold the baby in the womb till it is full term. In cervical incompetence, the cervix is unable to hold the baby when it reaches a certain weight, usually in the second trimester. The cervix would open early, with the water bag bulging through. Without any uterine contractions, the water bag would rupture and the baby delivered prematurely within a short time. Some mothers may feel slight pressure in the lower part of her abdomen or may have some mucous-like discharge prior to the delivery but in most cases, there are no warning signs.

The cause of cervical incompetence is not well-understood but seems to involve combination of inherent structural abnormalities and some external factors like inflammation. If the weakness of the cervix is due to a genetic reason, the miscarriage would happen in the first pregnancy. Otherwise, it may happen following a previous surgery on the cervix or trauma during a difficult birth or a D&C (dilation and curettage) from termination of pregnancy

An incompetent cervix can be difficult to diagnose and treat. If there is a history of fast miscarriage or premature birth in the second trimester, a procedure that closes the cervix with strong sutures (cervical cerclage) may be recommended in the subsequent pregnancy. After S had overcome her grief, she conceived again within a short while. At 14 weeks gestation, her cervix was found to be soft  and short. A cervical stitch using a synthetic tape was performed and S was advised to rest in bed most of the time. She was asked to abstain from sex and not to put on weight excessively by eating a well-balanced diet. Progesterone medication was given. Her antenatal course was closely monitored for infection.

Fortunately for S, her pregnancy this time progressed smoothly. The cervical tape was removed at 38 weeks of gestation and she delivered a healthy baby boy normally.

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