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Abnormal Cervical Function
By Eric Daiter, M.D.


The cervix is very important in the development of a pregnancy. The nonpregnant cervix is normally composed of a dense collagenous fibroconnective tissue with small amounts of smooth muscle to give it a tough texture. In pregnancy, the increased water content and vascularity in the cervix leads to a softening and a blue coloration. Throughout pregnancy the cervix and lower uterine segment change but maintain a "functionally intact" internal os.

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:

  • congenital abnormality in the composition of the cervix, with a relative deficiency in the tougher collagenous fibroconnective material or relative increase in concentration of the less tough smooth muscle.

  • congenital hypoplasia (underdevelopment) of the cervix, such as with in utero exposure to DES.

  • trauma to the cervix, such as with mechanical dilators for dilatation and curettage (D+C), cervical conization or extensive biopsy, and precipitous labors or cervical lacerations during labor and delivery.

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:

  • passing an 8 mm dilator into the nonpregnant uterus through the internal os (an office procedure)

  • a hysterosalpingogram (HSG) on the nonpregnant uterus to look for funneling of the lower uterine segment and an open internal os

  • ultrasonography of especially the pregnant uterus looking for shortening or dilatation of the cervix and bulging of the fetal membranes

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. Eric Daiter graduated from the University of Pennsylvania, where he was awarded an academic scholarship and was enlisted into the University Scholar's Program and the Benjamin Franklin Scholar's Program.

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.
34-36 Progress Street
Suite B-4
Edison, New Jersey, 08820

Web Site URL: http://www.drdaiter.com/index.html
E-Mail: info@drdaiter.com
Phone: (908) 226-0250
Fax: (908) 226-0830



The information presented in these articles are offered for informational purposes only. These pages have been written by Dr. Eric Daiter, yet are not intended to replace the medical advise offered by your personal physicians or healthcare professionals.

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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