Dr. Ahdoot shares what a woman should know about cervical insufficiency and high-risk pregnancy.
They should know that there are options now that perhaps weren’t there a few years ago. Many years ago, perhaps 20-30 years ago, if somebody had an abnormal Pap smear, the amount of cervix that was removed was much more than it is today, which could lead into cervical insufficiency or cervical incompetence. Other medical conditions can also lead into cervical incompetence.
What you should know is that cervical incompetence can be very tricky, and it doesn’t follow one rule versus the other. The most important thing is to be evaluated, to have constant evaluation by your physician, and for the patient to be aware of their own body so if they notice changes that are outside of normal they should visit their physicians sooner.
Furthermore, they should be aware of high-risk situations that can cause cervical insufficiency such as multiple gestations, such as pervious uterine or cervical procedures.
An example of this is I have had a patient that was referred from another gynecologist who had a shortened cervix due to multiple procedures on her cervix from an abnormal Pap smear. During her first pregnancy she had close surveillance and she did very well, delivered at term spontaneously.
During her second pregnancy her cervix was shorter than normal, and even though she had a normal pregnancy the first time, we were monitoring the cervix every other week.
We noticed the cervix was short; the patient was notified and she was basically on her toes and her visits became more frequent. Now she was being seen once a week and her cervix was been examined both by a pelvic exam and by ultrasound.
As the length of her cervix dropped to a point where she was at risk for pre-time labor, she was treated with steroids. She went on to deliver early at approximately seven and half, eight months, but the baby did very well.
Another example is a patient who had a history of having previous loss of a twin gestation due to cervical incompetence with her last pregnancy. In this pregnancy, it was monitored early; it was identified and a cerclage, which is basically a suture in the cervix was placed, and she went on to take that pregnancy to seven and half months which for multiple gestations is a very good outcome.
About Dr. David Ahdoot, M.D.:
David Ahdoot specializes in Obstetrics and Gynecology at Saint John’s Hospital in Santa Monica, California. He attended medical school at the University of California San Diego Medical Center. Later he went on to do his internship and residency at the University of California Irvine Medical Center. With more than 16 years experience, Dr. Ahdoot is a Diplomat of the American Board of Obstetrics and Gynecology.