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By Eric Daiter, M.D.
If the internal os of the cervix dilates or effaces during pregnancy this can be an ominous sign. In the beginning of pregnancy, cervical dilatation with some bleeding is known as an "inevitable abortion." In later pregnancy, cervical dilatation or effacement associated with lower abdominal cramps or pressure is a sign of labor (which is preterm if it occurs prior to 37 weeks gestation).
If there is painless dilatation or effacement of the cervix, usually occurring between the mid second trimester (about 20 weeks gestation) to the early third trimester (about 27-30 weeks), this is usually the result of an incompetent cervix. Pregnancy losses at progressively earlier gestational ages often reflect an incompetent cervix that gives way earlier with each subsequent pregnancy. The fetal membranes (chorionic and amniotic membranes) can sometimes be found bulging from the open cervix and can indeed hourglass through the cervix to fill the entire vaginal vault (which can be difficult to distinguish from a fully dilated cervix).
The causes of cervical incompetence can be congenital or acquired and include:
Establishing the diagnosis of cervical incompetence with certainty can be difficult. Generally, a suggestive history of late painless pregnancy losses with the history of a plausible cause is all that is used to diagnose the condition. Additional testing sometimes suggested to confirm the diagnosis (none of which have been widely accepted) includes:
Treatment of an incompetent cervix is surgical. The cerclage is an attempt to strengthen the cervix, with the two most commonly used modern techniques having been developed in the 1950s by Drs. Shirodkar and McDonald. These techniques involve the surgical placement of a suture or Mersilene band around the cervix to hold it closed. In appropriately selected women, the improvement of pregnancy outcome with a cerclage is seemingly impressive. Generally, 80-90% of women with cervical incompetence as their cause for recurrent pregnancy loss will deliver a viable live born following cerclage placement.
Dr. Daiter graduated medical school at Temple University Medical School in Philadelphia and completed the Obstetrics and Gynecology residency program at Albert Einstein College of Medicine in New York. He completed his Reproductive Endocrinology and Infertility fellowship at the Hospital of the University of Pennsylvania. He has considered a career as a physician scientist in research medicine and has published several articles on molecular events that occur during the human embryo's implantation into the uterus.
Dr. Daiter entered private practice in 1994, where he joined a successful referral based infertility practice and further developed his clinical skills. Dr. Daiter emphasizes the basic principles of infertility patient care, including the importance of highly personalized, cost considerate, state of the art, one on one care for his patients. He specializes in all aspects of In Vitro Fertilization, with a patient success rate among the highest in the state. He has performed several hundred advanced operative laparoscopic and hysteroscopic surgeries, utilizing the most modern laser techniques.
Dr. Daiter opened his Edison, NJ office in 1997. The office continues to support the highest level of professional care for infertile couples. Extended office hours are available for patient convenience.
Eric Daiter, M.D.
All rights reserved. No part of the material protected by this copyright notice may be reproduced or utilized in any form, electronic or mechanical, including photocopying, recording, or by any information storage and retrieval system, without written permission from the copyright owner.
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