Can cervical incompetence be remedied?
If a diagnosis of an incompetent cervix is made, following such a miscarriage, remedial action has to wait until she has conceived again. Corrective action is taken after fourteen weeks, when the possibility of spontaneous miscarriage from other causes has receded to negligible, and a scan has verified that the fetus and placenta are growing normally. Fourteen weeks is also just before entering the danger period of miscarriage caused by cervical incompetence. What does corrective action involve? The commonly used method is to put a special suture in the weakened cervix to close it and hold it in that closed state. The procedure is called “cervical cerclage” and, depending on how the suture is made, names for the procedure such as Shirodikar and Macdonald will be used. It is in most cases done vaginally, and the suture is subsequently removed at thirty-eight weeks of gestation, ready for labour. The insertion of the stitch is done in theatre under a general anaesthetic. Many obstetricia
