What traumatic conditions might be associated with miscarriages?
The cervix (neck of the womb) should remain closed through pregnancy but in labour it must stretch to allow the baby through. Cervical incompetence is characterised by weakness of the cervix allowing it to open without the typical labour pains, expelling the fetus during the middle weeks of pregnancy (mid-trimester miscarriage). For the cervix to be incompetent the internal os (top end of the cervix) must be weak. It is possible for the cervix to be weak from the outset particularly in association with congenital uterine abnormality. Cervical incompetence can result from outmoded traumatic obstetric delivery but we now resort to Caesarean section rather than difficult forceps delivery. Stretching the cervix beyond 10mm to terminate pregnancy may be a factor in cervical incompetence and every care is taken to avoid damage to the cervix during these procedures. Cone biopsy of the cervix (Q12.14) could theoretically damage the cervix but again care is taken to avoid the internal os and studies of the outcome of pregnancy following the modern loop cone procedures provide reassurance.
The diagnosis of cervical incompetence is not easy. Painless miscarriage may occur when there was no apparent reason to predict that this would occur. Serial ultrasound assessment of the cervix looking for evidence of the internal os opening may be a reasonable approach. The treatment of cervical incompetence is a special stitch (cervical cerclage), which acts as a purse-string. No operation is without complication (surgery risks). Controlled studies (Q33.24) have not demonstrated that cervical cerclage is as beneficial as we originally believed. An interesting recently published concept is that the stitch may work by preventing bacteria ascending from the vagina into the uterus rather than as a mechanical barrier stopping the cervix from opening.
Please click on the required question.
- 1 What is a miscarriage?
- 2 What are the different types of miscarriage?
- 3 How accurate are pregnancy tests?
- 4 What is a blighted ovum?
- 5 I have had a hydatidiform mole. What is this?
- 6 Why did I have a spontaneous miscarriage?
- 7 How frequently do miscarriages occur?
- 8 I am miscarrying. How should this be treated?
- 8a Can miscarriage result in anxiety and depression?
- 9 What is meant by recurrent miscarriage?
- 10 I have a problem with recurrent miscarriage. What is the chance of my next pregnancy being successful?
- Q 12.11 Recurrent Miscarriage I have miscarried again. Why does this keep happening?
- 12 What congenital problems might be associated with recurrent miscarriage and how could they be treated?
- 13 What traumatic conditions can cause recurrent miscarriage and how can they be treated?
- 14 Can infection cause recurrent miscarriage and would treatment help?
- 15 Could a metabolic disorder cause recurrent miscarriage?
- 16 Could a hormonal problem account for recurrent miscarriage and would hormone treatment help me?
- 17 Could an autoimmune problem cause recurrent miscarriage and how could this be treated?
- 18 Could a tumour cause recurrent miscarriage?
- 19 What degenerative processes may be associated with recurrent miscarriage?
- 20 After every miscarriage I become more depressed. Could this account for the problem?
- 21 Is it always possible to explain recurrent miscarriage?
- 22 I have a problem with recurrent miscarriage. What treatment is available to ensure that this does not happen again?
- 23 What is an ectopic pregnancy?
- 24 How frequently do ectopic pregnancies occur?
- 25 Why do ectopic pregnancies occur?
- 26 How can an ectopic pregnancy be diagnosed?
- 27 How can an ectopic pregnancy be treated?
- 28 Where can I obtain more information?
- 29 Support Groups.
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This is the personal website of David A Viniker MD FRCOG, Consultant Obstetrician and Gynaecologist at Whipps Cross University Hospital, London - Specialist Interests - Reproductive Medicine including Infertility, PCOS, PMS, Menopause and HRT.
I do hope that you find the answers to your women's health questions in the patient information and medical advice provided.
