Cervical insufficiency or incompetent cervix can increase the risk of second-trimester loss if left untreated. Darin Swainston, MD, FACOG provides diagnosis, treatment, and ongoing management of cervical insufficiency at his Las Vegas practice. Minimally-invasive procedures to correct cervical incontinence and prevent preterm birth improve the chances of successful pregnancy and delivery.
A healthy cervix stays tightly closed throughout pregnancy and begins to open as the due date nears. In women with cervical insufficiency or incompetence, the weight of the fetus causes the cervix to open much earlier – between 16 and 24 weeks gestation – causing pregnancy loss in the second trimester.
The condition is uncommon but devastating. Because many women who have experienced pregnancy loss due to an incompetent cervix don't attempt to have children again, the number of women affected is unknown.
An incompetent cervix can be the result of a congenital disability. A previous D & C (dilation and curettage), LEEP procedure, or cold knife conization can put women at higher risk of cervical incompetence.
Dr. Swainston often discovers cervical insufficiency after a second-trimester loss. Women who have a known incompetence or women who are at high risk of incompetence can be monitored closely via ultrasound during the first and second trimester. Perinatologists normally make the determination if abdominal cerclage should be offered during first trimester or prior to pregnancy.
Transabdominal cerclage is the treatment of choice for cervical incompetence if vaginal cerclage has failed in past pregnancy. It's inserted near the top of the cervix through laparoscopic incisions in the abdomen and prevents the cervix from opening prematurely. Once Dr. Swainston inserts the cerclage, it stays throughout the pregnancy and can even remain to protect future pregnancies. The child must be born via cesarean section.
The most encouraging news is that Dr. Swainston can perform transabdominal cerclage before conception when cervical insufficiency is known in advance. This improves the chances of a positive result for women who have a history of second-trimester loss without performing a surgical pregnancy during pregnancy. Many times patients are pregnant prior to having this surgery which requires the procedure to be done in first trimester of pregnancy.
Robotic-assisted surgery is both minimally invasive and highly effective in treating cervical incontinence and preventing preterm birth. Sometimes there is no bed rest required after robotic-assisted surgery for cervical incompetency, and it can dramatically improve the lives and outcomes of women with this condition. Dr. Swainston has over 20 years of experience in the treatment of cervical incontinence and is an expert in the use of robotics in gynecologic surgery.
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"If you're looking for someone who will be upfront & honest, who cares about you and your baby and your delivery, who is experienced, Dr. Swainston is a great doctor."
"I have been seeing Dr. Swainston for over 16 yrs. He is totally awesome!!! I love him and his staff."
"Dr. Swainston has been my doctor for 8 years now. He delivered my first son & will soon deliver my second. He's an amazing doctor and is worth it..."
"I was so lucky to have Dr. Swainston deliver my twin boys. No matter how busy he was, he was always funny & personable."
"Took my partner to Dr. Swainston, she was very comfortable and he seems to be a pretty good doctor."
"Dr. Swainston has been my OBGyn since 2011 when I first got pregnant. Two babies later I can safely say Dr Swainston is the best!!"
Dr Sawinston is AMAZING!!