What is Cervical Incompetence?

McDonald Cervical Cerclage

[vc_row][vc_column][vc_column_text]A few weeks ago, a friend rang me up and told me that her doctor had just called her cervix incompetent. Here is how our conversation went.

Friend: Hello?

Me: Long time I have missed you.

Friend: (Sounding bored) Well, yeah, been busy

Me: Are you okay?

Friend: Actually, the doctor I am seeing just called my cervix incompetent

Me: Oooh, I um…..

Friend: I will sue him. How can he talk like that? Is that even professional?

Me: Haha haa haaaa

Friend: ( Hangs up).

An incompetent cervix is one that opens prematurely under the pressure of the growing fetus and results in early second trimester miscarriages.

Causes of cervical incompetence include:

1. Genetic weakness of the cervix

2. Severe laceration during previous pregnancies

3. Multiple gestation (twin, triplet, etc)

People with cervical incompetence normally experience multiple pregnancy losses all which occur in the second trimester of pregnancy.

The treatment usually involves placement of a cervical stitch (MC Donald’s stitch) that closes the cervix and prevents it from opening usually from the 12th to the 16th weeks of pregnancy

Your doctor will need you to abstain from sex if you have a MC Donald’s stitch in place till delivery.

People with MC stitch can still deliver vaginally except, the stitch will need to be removed before delivery or any time after the 37th week of pregnancy.[/vc_column_text][/vc_column][/vc_row]

Pre-Conception Care

Pre-Conception Care

Well before each baby is conceived, the two parents involved should actually decide to conceive the baby (as opposed to find yourself pregnant), carry the pregnancy to term and give birth to a healthy baby, while ensuring the mother is healthy throughout the pregnancy and during the post delivery period. During the preparation phase of conception, the two parents to be should undergo pre- conception care.

Pre- conception care is the care given to both men and women who are planning to conceive, with the aim of increasing chances of conception, and reducing the risk of death during pregnancy, with an aim of giving birth to a healthy baby.

It offers patients an opportunity to discuss risk factors that can be minimized before and during pregnancy to ensure a healthy outcome for the mother, father and the baby. The issues to be discussed and addressed include;

Contraception
Couples on contraception who wish to get pregnant should discuss it with their obstetrician and gynecologists. Those on implants and intra-uterine devices should have them removed. Those on three monthly injections should be counselled on the possibility of a delay in the return to fertility for about three or so months.


Maternal chronic diseases

Before pregnancy, women who suffer from chronic diseases like diabetes, hypertension, epilepsy, HIV should be seen by their gynecologists. They should be treated to a level where their diseases or the drugs they take won’t affect the well being of the baby.

    Diabetic women

should have their sugars well controlled before they become pregnant. They should also have their medicines changed from oral tablets which have teratogenic potential to insulin injections.

Pre-Conception Care
Pre-Conception Care

    Hypertensive women

should have their pressures well controlled before pregnancy. They should also discuss the potential to have their drugs changed to drugs that have no teratogenic potential.

    Epilepsy

– women with epilepsy and who are on medications should not ideally get pregnant without discussing it with their doctors. Most of the anti-epileptic drugs they use may cause birth defects such as spina bifida. They are therefore supposed to be started on a course of folic acid supplementation several months before they become pregnant. They should also have their drugs changed to drugs that don’t cause fetal defects.

    HIV positive women

should be put on anti-retrovirals till their viral load is undetectable so as to reduce the possibility of mother to child transmission.

    Hyperthyroidism

– women using anti-thyroid drugs should be seen by their doctors and advised if at all getting pregnant is safe at all. They should also have their drugs changed to drugs that don’t cross the blood placental barrier hence causing fetal defects.

Mental illnesses
Such as depression and anxiety disorders should be screened and treated before pregnancy. Women who are on continuous treatment for mental illnesses should be put on medications that are safe for the child who is about to be conceived.

Nutrition
All women desiring pregnancy should have their nutrition assessed. They should start feeding on folic acid rich foods and taking folic acid supplements if need be. Folic acid prevents against neural tube defects.

Obesity
Women with a body mass index (BMI) of 30 and above should be advised to lose some weight. Obesity is a risk factor for infertility among women. It is also a risk factor for other pregnancy complications like deep venous thrombi i.e clots.

Sexually transmitted diseases
Both parents should be screened and treated for sexually transmitted illnesses such as syphilis so as to eliminate the risk of transmitting it to the unborn baby.

Family and Genetic history
Assess pregnancy risks on the basis of maternal age, maternal and paternal health, obstetric history and family history. Possibility of passing genetic defects like sickle cell to the unborn baby should be discussed.

Advanced maternal age and the risk of getting babies with Down syndrome should also be discussed.

Images courtesy of Citizen Kenya & Lune Magazine

Health Is Now Devolved

Photo source: The Sun Nigeria.

A twenty-year old walks to the County referral hospital with the dignity of a married woman, tummy protruding before her, she is walking with her legs slightly apart, thanks to her protruding belly. She is in the company of three women; her mother in law, her own sister and an elderly neighbor. Every twenty or so minutes, she pauses, puts her hands on her waist and takes long purifying breaths as a strong contraction starts at the fundus of her uterus and radiates down, causing indescribable pain. The long, slow breathing, she has realized helps. She is hopeful that everything will be fine, she is not worried about anything. The most important thing to her is that she is married. This child is not a bastard. He (she hopes it will be a son) has a father and hence a future.

At the entrance to the wards, she is allowed in without delay. The security people don’t keep women with protruding bellies and dancing feet waiting. She is ushered into the maternity ward. The admitting doctor gets her details. She is a first time mother. She doesn’t remember when she got her last period, like ninety percent of all the women admitted into maternity. Currently she has low abdominal pain, that begun about sixteen hours before she presented to the hospital. Her baby is kicking just fine but her water hasn’t broken. The admitting doctor notes that. She asks for the antenatal clinic book. She is handed a purple booklet which, except for the name, is essentially blank. ”Mama ulienda clinic?” She asks. The patient answers in the affirmative. How many times? Once. The reason why no test was ever done is because she was unable to go back a second, third and fourth time. The county health care workers were all on strike over unpaid salaries. She couldn’t afford the private hospitals because she has no insurance cover. And she couldn’t go to the next county hospital either because she had no bus fare.

The doctor performs her examination and realizes she is carrying twins. Her cervix is five centimeters dilated. She hastily draws blood, to check her hemoglobin level and do other basic tests like HIV testing, blood grouping, et cetera. Her HIV sero-status comes out positive, her hemoglobin level a mere seven. The doctor summarizes the patient’s condition; “a first time mother, who is anemic and HIV positive, carrying twins, never been on ARVs.” This is definitely a recipe for post-partum hemorrhage and other chaos.

She decides to look for blood for her just in case she develops post-partum hemorrhage. When she goes to the lab, the fridge is opened so that she can see for herself that there is no blood. Because seeing is believing. So the doctor goes back to the ward just to consider her options; take out her prayer beads and say a continuous prayer for the poor clue-less woman. Pray that she delivers safely. Pray that she doesn’t bleed excessively after delivery, or refer her to the next county hospital. Her cervix is now nine centimeters dilated. The first baby will be born about one hour from now. The next county hospital is one hour thirty minutes away. So referral is clearly out of question. but she still calls the hospital for the sake of it. But the person on the other end is so sorry they also don’t have blood. So the doctor goes back and sits in the maternity ward and waits for a miracle, the miracle of safe delivery, good health to the mother and the babies. Because she can’t have a maternal mortality. Mothers shouldn’t die when bringing a new life to earth. And also mothers shouldn’t die because maternity care is “free” paid for by the government. Our dear government!

PREGNANCY DANGER SIGNS

While some symptoms could wait till the next ante natal visit, other symptoms require immediate medical attention.
Here are some of those symptoms that need immediate medical attention;
Bleeding
Any bleeding during pregnancy warrants immediate medical attention.
First trimester bleeding accompanied with severe abdominal cramps could mean; ectopic pregnancy, a condition where a fetus is implanted outside the uterus.
First or second trimester bleeding could also mean a miscarriage.
Third trimester bleeding- could be caused by a low lying placenta or placenta abruption i.e. separation of the placenta from the uterine lining.
Severe headache
A severe persistent headache associated with visual disturbance and abdominal pain could mean pre- eclampsia, a condition associated with increases blood pressure, and passing of proteins in urine.
Pregnant women who experience these symptoms should see their obstetricians ASAP.
Severe nausea and vomiting
Nausea and vomiting is a common phenomenon in pregnancy
There are however women who experience severe nausea and excessive vomiting, a condition termed hyper- emesis gravidarum in medical circles.
Severe vomiting could lead to dehydration, and even low blood sugar levels
A pregnant woman who vomits virtually every food eaten should seek medical help
Decreased fetal activity
Most women will start perceiving fetal kicks at around week 20 of pregnancy.
A perceived decrease in fetal kicks needs the attention of a doctor sooner than later.
Your water breaks
“Water” or amniotic fluid is colorless.
If your water breaks, you will feel a gush of fluid rushing down your legs.
The event is often painless and some women may ignore it, but with time, infection may set in.


Excessive thirst, hunger and frequent urination
Especially in the second trimester could mean gestational diabetes.
Gestational diabetes is a disorder of blood sugar regulation that occurs in pregnant women
If a woman experiences the three symptoms, then their blood sugar level should be tested to rule out diabetes of pregnancy

Calf pain and swelling
Unilateral leg swelling, associated with increased temperature and pain on the calf area may mean there is a clot in one of the deep veins of the legs
This condition is called deep venous thrombosis and is a common phenomenon in pregnancy
Women who experience these symptoms should seek for medical care as soon as is possible

To be pregnant is to be vitally alive, thoroughly woman, and distressingly inhabited. Soul and spirit are stretched- along with body – Anne Christian