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Expert Q&A

	By Traci Kurtzer Obstetrician and Gynecologist

During my last pregnancy, I went into labor at 21 weeks and I lost my daughter. They say I may have had an incompetent cervix. How do they determine this? What are they risks if I decide to get pregnant again?

An incompetent cervix is usually diagnosed after a woman presents, usually between 15 to 24 weeks into her pregnancy, with painless cervical dilation (i.e. dilation that preceded or was not caused by uterine contractions). We think the cervical connective tissue is weakened and unable to contract to hold in the growing fetus. A prior history of surgery or congenital abnormalities of the cervix would make one's suspicion higher. In general, it can sometimes be very difficult to diagnose.

If you were to get pregnant again, you may be at higher risk for another early pregnancy loss. Your doctor may suggest monitoring the cervix for signs of shortening or early dilation by means of regular digital examinations or ultrasounds. Or he or she may suggest you consider a preventative "cerclage" which is a procedure in which a thick suture is tied around the cervix in an attempt to hold it shut. Later in the pregnancy, when you are closer to term, it can be removed to allow delivery. This procedure has potential risks, so it's important for you to make an informed decision by discussing it with your doctor.

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