Treatments for or approaches to managing an incompetent cervix might include:
- Progesterone supplementation. If you have a history of premature birth, your health care provider might suggest weekly shots of a form of the hormone progesterone called hydroxyprogesterone caproate (Makena) during your second trimester. However, further research is needed to determine how progesterone might specifically help women who have cervical insufficiency. Progesterone also isn't recommended for women pregnant with more than one baby.
- Serial ultrasounds. If you have a history of early premature birth, your health care provider might begin carefully monitoring the length of your cervix by giving you ultrasounds every two weeks from week 15 through weeks 24 to 26 of pregnancy. If your cervix begins to open or becomes shorter than a certain length, your health care provider might recommend cervical cerclage.
- Cervical cerclage. If you're less than 24 weeks pregnant or have a history of early premature birth and an ultrasound shows that your cervix is opening, a surgical procedure known as cervical cerclage might help prevent premature birth. During this procedure, the cervix is stitched closed with strong sutures. The sutures might be removed during the last month of pregnancy or during labor. If you have a history of premature births that's likely due to cervical insufficiency, your health care provider might also recommend cervical cerclage before your cervix begins to open (prophylactic cerclage). This procedure is typically done before week 14 of pregnancy. Cervical cerclage isn't appropriate for everyone at risk of premature birth, however. Be sure to talk to your health care provider about the risks and benefits of cervical cerclage.
Your health care provider might also recommend the use of a device that fits inside the vagina and is designed to hold the uterus in place (pessary). A pessary can be used to help lessen pressure on the cervix. However, further research is needed to determine if a pessary is an effective treatment for cervical insufficiency.
Mar. 23, 2012
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- Annum EA, et al. Health disparities in risk for cervical insufficiency. Human Reproduction. 2010;25:2894.
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- Healthy pregnancy: Staying healthy and safe. U.S. Department of Health and Human Services Office on Women's Health. http://www.womenshealth.gov/pregnancy/you-are-pregnant/staying-healthy-safe.cfm. Accessed Feb. 13, 2012.
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- Makena (prescribing information). Bridgeton, Mo.: Ther-Rx Corp.; 2011. http://www.makena.com/media/PDFs/full-pi.pdf. Accessed Feb. 13, 2012.
- FDA approves drug to reduce risk of preterm birth in at-risk pregnant women. U.S. Food and Drug Administration. http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm242234.htm. Accessed Feb. 13, 2012.
- Berghella V, et al. Patients with prior second-trimester loss: Prophylactic cerclage or serial transvaginal sonograms? American Journal of Obstetrics and Gynecology. 2002;187:747.
- Baramki TA. Hysterosalpinography. http://www.uptodate.com/index. Accessed Feb. 13, 2012.
- Harms RW (expert opinion). Mayo Clinic, Rochester, Minn. Feb. 15, 2012.
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