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Case Study: It Wasn't Easy For This Mother With Cervical Insufficiency To Deliver Her Baby

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Case Study: It Wasn't Easy For This Mother With Cervical Insufficiency To Deliver Her Baby
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Cervical insufficiency happens when the uterus is unable to sustain a pregnancy until full term. Many second-trimester miscarriages and neonatal deaths are caused by cervical incompetence.

Written by Prerna Mittra |Updated : December 7, 2023 4:01 PM IST

Pregnancy is a unique journey. The nine months of gestation period may be smooth for some women, but for others, it may be fraught with challenges. For this 35-year-old woman, who gave birth to a preterm baby, it was quite a harrowing experience. She had been suffering from, what is known as, cervical insufficiency, but managed to give birth under challenging circumstances. Read on to know more about her story.

For the mother, the pregnancy was complicated, critical and high-risk, because of cervical insufficiency. She was assisted by a team of doctors from Motherhood Hospital Kharghar, led by Dr Shaifali Patil, consultant obstetrician and gynecologist, and Dr Suresh Birajdar, consultant neonatologist and pediatrician. The baby weighed 1.5 kg during delivery and received NICU care for 24 days to ensure his well-being and development.

The patient, an engineer by profession, and her partner who serves in the Merchant navy, were overjoyed when they learned they were expecting their first child. But, cervical insufficiency was discovered at 20 weeks, leading to a dilated cervix of 2 cm.

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What is cervical insufficiency?

It happens when the uterus is unable to sustain a pregnancy until full term. Many second-trimester miscarriages and neonatal deaths are caused by cervical incompetence. In the second trimester, if the membranes prolapse in the vagina because of cervical incompetence, it can be technically "very difficult" for the gynecologist to push the membranes back in the cervix and apply cerclage to prolong the pregnancy.

In this patient's case, following thorough counselling, the team of doctors performed a cervical cerclage, physically closing the open 'cervical OS', which is the opening in the cervix at each end of the endocervical canal.

The cervical cerclage process

The mother-to-be underwent cervical cerclage at 20 weeks of gestation. It is a surgical procedure, in which a stitch is placed around the cervix to provide support and prevent premature opening.

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At 28 weeks, however, it was discovered that the cervical OS was open again, indicating a potential risk of preterm labor. The patient was advised bed rest, to limit physical activity and minimise stress on the cervix. Around the 30th week, she went into labor with a breech presentation so a combined decision of a lower (uterine) segment caesarean section (LSCS) was taken.

"Immediate decision-making is crucial in high-risk pregnancies. Detecting and addressing complications such as cervical insufficiency early can prevent premature birth or miscarriage. Regular monitoring and follow-up are necessary. In [this patient's] case, a second cervical stitch was performed promptly when the initial cerclage did not work. Strict bed rest and close monitoring are recommended, with regular sonography to track progress. Emotional support and counselling with patients and their families are crucial. Overall, immediate decision making and skilled care can ensure a safe and successful pregnancy outcome," said Dr Patil.

Given that the birth was premature, the infant received care in the NICU for respiratory distress syndrome (RDS) and overall recovery.

"The baby experienced the prematurity condition of RDS and was given CPAP support. Throughout the recovery process, we ensured that the mother practised kangaroo mother care (KMC), involving skin-to-skin contact. After 3 weeks of receiving specialised care in NICU, the baby boy's weight increased to 2 kilograms, and both mother and the baby were discharged from the hospital," said Dr Birajdar.