In Cervical Incompetence (CI), the cervix is weak & will open before the baby reach term and hence delivered prematurely at less than 37weeks. Preterm babies may not survive, require respiratory support, feeding support, and are also at risk of infection. Managing preterm baby is stressful and costly for a couple. CI is diagnosed by past history of fetal loss or preterm delivery, shortening of cervical length & opening of internal cervix canal in the absence of labour.
Treatment is aimed at prolonging the pregnancy to 37 weeks by lifestyle changes, adequate rest, progesterone injection, progesterone pessary, cervical cerclage, dexamethasone injection (mature baby’s lungs). The cervical cerclage will strengthen the cervix by lengthening the cervix and closing the internal os. If detected before 24 weeks, a McDonald cerclage can be inserted and after which, an Arabin cerclage is used.
Patient VN, a doctor at government hospital had her 1st IVF at Metro IVF. She had low ovarian reserve (AMH=5). So, she had a fresh embryo transfer cycle using day 2 embryo to avoid loosing her 2 embryo. She successfully conceived.
However, at 26 weeks, her cervix shortened to 21mm and internal os was opening. She was diagnosed to have CI & advised lifestyle change, rest, given progesterone injection weekly. An Arabin cerclage was inserted encircling the cervix (see pic). The Cervical length increase from 2.1cm to 2.8cm & internal Os closed.
Her pregnancy continued for another 9 weeks when she went into active labour at 35 weeks. She had an emergency Cesarean surgery and delivered a healthy baby girl, photo below.
The combined treatment including Arabin cerclage has prolong her pregnancy for 9 weeks and prevented all the problems associated with preterm baby. Thus, saved her stress & cost.
AMH: hormone that measures egg reserve
Arabin cerclage: Silicon ring device inserted vaginally to encircled the cervix
ET: Embryo Transfer
Internal Os: opening at the inner end of cervical canal
McDonald cerclage: a tape that is tied around and strengthen the cervix