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 the best use of progesterone in cervical insufficiency. Currently, progesterone treatments don't seem to be helpful for pregnancy with twins or more.
- Serial ultrasounds. If you have a history of early premature birth, or you have had cervical damage in previous deliveries or operations, your health care provider might begin carefully monitoring the length of your cervix by giving you ultrasounds every two weeks from week 15 through week 24 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 are 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 will 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. For example, the procedure isn't recommended for women carrying twins or more. 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.
March 12, 2015
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- Gabbe SG, et al. Obstetrics: Normal and Problem Pregnancies. 6th ed. Philadelphia, Pa.: Churchill Livingstone Elsevier; 2012. http://www.clinicalkey.com. Accessed Dec. 14, 2014.
- Papadakis MA, ed., et al. Current Medical Diagnosis & Treatment 2015. 54th ed. New York, N.Y.: The McGraw-Hill Companies; 2015. http://accessmedicine.mhmedical.com/book.aspx?bookID=1019. Accessed Dec. 14, 2014.
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- Cervical insufficiency. The Merck Manual Professional Edition. http://www.merckmanuals.com/professional/gynecology_and_obstetrics/abnormalities_of_pregnancy/cervical_insufficiency.html#v1073896. Accessed Dec. 14, 2014.
- American College of Obstetricians and Gynecologists (ACOG) Committee on Practice Bulletins — Obstetrics. ACOG Practice Bulletin No. 142: Cerclage for the management of cervical insufficiency. Obstetrics & Gynecology. 2014;123:372.
- What can I do to promote a healthy pregnancy? National Institute of Child Health and Human Development. http://www.nichd.nih.gov/health/topics/preconceptioncare/conditioninfo/pages/healthy-pregnancy.aspx. Accessed Dec. 18, 2014.
- Harms RW (expert opinion). Mayo Clinic, Rochester, Minn. Dec. 19, 2014.