Posts Tagged ‘cerclage’

Pregnancy after a preemie

Friday, November 13th, 2015

You may know that having had a premature baby increases your risk to give birth early in your next pregnancy. No one knows for sure what causes a woman to have a premature baby. However, it is important to understand what factors may make you more likely to give birth early and understand how you may be able to reduce your risk.

When you are ready to think about having another baby after you have had a preemie, here are some things to consider:

When to get pregnant again

Getting pregnant too soon after having a baby increases your chance of giving birth early. If possible, wait at least 18 months between giving birth and getting pregnant again. This gives your body time to recover.

Manage preexisting health conditions

Having diabetes or high blood pressure puts you at a higher risk to have a premature baby. Talk to your health care provider about how to best manage these conditions before you get pregnant again. And weighing too much or too little can also be a risk factor. Try to get to a healthy weight before you get pregnant again.

Prevent infections

Having an infection during pregnancy may increase your chance of giving birth early. Always wash your hands thoroughly and practice good hygiene. This won’t prevent all infections, but it can help. Also, get tested for STDs before you become pregnant.

Treatments for preterm labor

Some women may be able to receive progesterone treatment or cerclage in their next pregnancy to reduce their chances of giving birth early again. Talk to your provider to see if these treatments may be right for you.

In the video below, Dr. Siobhan Dolan discusses who may be a good candidate for progesterone treatment:

If you are planning on getting pregnant again, make sure you talk to your health care provider about what you may be able to do to reduce your risk of premature birth. Together, the two of you can make a plan so that hopefully your next pregnancy can be closer to 40 weeks. You can also go to our online community Share Your Story to talk to other women who gave birth early and are planning a pregnancy or are pregnant again.

Have questions? Text or email us at AskUs@marchofdimes.org.

What is cervical insufficiency?

Monday, August 16th, 2010

Cervical insufficiency (sometimes called incompetent cervix) refers to a cervix that opens too early during pregnancy, usually without pain and contractions. This most often occurs in the second or early third trimester of pregnancy, resulting in late miscarriage or premature birth. A woman may be diagnosed with cervical insufficiency based largely on this history. There is no specific diagnostic test.

Medical experts don’t always know why cervical insufficiency occurs. Factors that may contribute include:
• Uterine defects: Women with certain uterine defects, such as bicornuate uterus (two cavities), are more likely to have cervical insufficiency than women without these defects.
• History of surgical procedures involving the cervix: These include LEEP (loop electrosurgical excision procedure), which is used to diagnose and treat abnormal cells found during a Pap test.
• Injuries during a previous birth.
• Short cervix: The shorter the cervix, the more likely the woman is to have cervical insufficiency. In some cases, a short cervix can be congenital.

Miscarriage and premature birth due to cervical insufficiency frequently happen again in another pregnancy. These problems can sometimes be prevented with a procedure called cerclage, in which the provider places a stitch in the cervix to keep it from opening too early. The provider removes the stitch when the woman is ready to give birth.

It is not always clear which women will benefit from cerclage. This is because there is no specific test for cervical insufficiency, and many women who have had a late miscarriage or early premature birth go on to have normal pregnancies without treatment. Some studies suggest that cerclage is most likely to be beneficial in women who have had three or more late miscarriages or premature births. In some cases, providers may monitor a woman suspected of having cervical insufficiency with repeated vaginal ultrasounds to see if her cervix is shortening or showing other signs that she may give birth soon. The provider may recommend cerclage if these changes occur.

Some women learn that they have a short cervix during a routine ultrasound. Most of these women do not end up having a premature birth. However, short cervix, especially a very short cervix (less than 15 millimeters), does increase her risk of premature birth. Studies suggest that treatment with the hormone progesterone (17P) may help reduce the risk of premature birth in women with a very short cervix. According to the American College of Obstetricians and Gynecologists (ACOG), progesterone treatment may be considered for these women. However, ACOG does not recommend routine cervical-length screening for low-risk women.