What is Cervical Insufficiency?

In simple terms, Cervical Insufficiency is a condition where the cervix prematurely shortens, dilates and effaces before a pregnancy comes to term. In normal pregnancies the cervix will begin to shorten, efface and dilate around 38-40 weeks of pregnancy. In my case, my cervix began to shorten around 19 weeks of pregnancy, when my baby had gained enough weight to put pressure on my cervix. I am one of the lucky ones because the ultrasound tech noticed it at my routine anatomy scan. Most women are not so lucky and when CI is not caught, most likely leads to a second trimester miscarriage or preterm labor.

CI occurs in 1-2% of pregnancies, making it an infrequent but devastating condition. Now you may be wondering, how do women get Cervical Insufficiency? Well, there are a multitude of reasons. Women who have had multiple second trimester D&C's are at risk, as well as women who have had surgical procedures on their cervix. Some women are simply born with it. I am the latter. CI is not something that you can get rid of either. It follows you forever and thus, I will never have a "normal" pregnancy.

Cervical Insufficiency was first noted around the 1860's but there hasn't been many advances to prevent the problem other than a  Transvaginal Cerclage or TVC. TVC's were first studied in the 1950's and are still considered controversial because what works for one woman may not work for another. TVC's are a small stitch placed in the cervix and pulling it tight like a purse string to keep the baby inside the uterus. Many times women still efface (thin) right down to the stitch which means bed rest at that point. One other advancement has been made, a better and more effective version of TVC, a Transabdominal Cerclage or TAC, which is a surgical procedure where the doctor makes an incision at the bikini line and places a small, woven synthetic band high on the cervix. The TAC has a 95% success rate and can be done pre-pregnancy or in very early pregnancy. TAC's can even be left in for future pregnancies but the downside is that you are only able to have a C-section. Vaginal deliveries are not possible with a TAC. Unfortunately, there are only a few doctors in the United States that perform the procedure. Dr. Haney, out of University of Chicago Medicine, is one of them. If I decide to have another baby, I will most likely travel to Chicago to have this procedure done.

Other than TVC and TAC, the only other treatment for Cervical Incompetence is the use of progesterone. Progesterone can be administered via suppository or for women who meet the criteria, as a shot known as P17. In my case, the Maternal Fetal Medicine specialist at Beaumont prescribed me 200 mg of progesterone via suppository. Along with the medicine, my personal OB put me on bed rest that went from two weeks to the rest of my pregnancy. Even with the progesterone and bed rest, my cervix shortened, effaced and dilated.

At a cervical ultrasound at 21 weeks, I was whisked to Triage and the doctors there gave me a grim diagnosis. They did not believe I would make it to 22 weeks and sent me home to wait for a miscarriage. Feeling like all was lost, I had an epiphany when I felt my baby kick. I realized that she was still here and that it was not over until it's over. Doctors are not God. They don't have a crystal ball. So, armed with an I-Won't-Take-No-For-An-Answer attitude, I found a new practice of doctors that wouldn't give up on me. And despite my previous OB's doubts, here I am at 25 weeks and 4 days. Albeit in a hospital bed, I do feel safer here than I did at home. Beaumont is not close to where I live and if anything had happened, it would most likely be too far for the doctors to do anything. Luckily, my doctors admitted me when I was nearly 24 weeks on the dot since I was now at the point where my baby had a chance to survive outside the womb. In three weeks my cervix had dilated to about 1.5cm and was 90% effaced with bulging membranes, which means the amniotic sack is now protruding into the vaginal canal. In L&D, they administered magnesium sulfate via IV to prevent preterm labor and gave me two steroid shots, one in each hip, to help my baby's lungs mature faster. Those 24 hours were long, exhausting and uncomfortable but I made it out and was transferred to antepartum.

Now I await the day until my little lady decides to make her appearance or more accurately, when my cervix gives up. We are hoping for at least 28 weeks. Right now she's diagonal in my abdomen, with her head in my hip. If she stays that way I will have to have a classical Cesarean section, where the incision is vertical rather than at the bikini line. If that is the case I will never be able to have a VBAC but as long as my baby is okay, I don't care. What I've learned about motherhood thus far, even before my baby has been born, is that it is almost completely sacrifice. I have sacrificed my dignity (bed pans are not fun), my life (work, shopping, eating out) and my body. I had dreamed of an uncomplicated pregnancy and vaginal delivery but now I am faced with C sections, the NICU and the reality that my baby will have to be on a ventilator and feeding tube to survive. So much for the birthing and breastfeeding classes or the hospital tour. The hospital is my home now and every day is a new day and one step closer to a healthy baby. For the first time in six weeks I know that everything will be okay.