Early Cervical Screening in Pregnancy Now
In a time where we are going over pro-life and pro-choice, we have babies dying due to the fact that early cervical screenings are not offered…not even mentioned as a choice.
In the article “The Short Cervix and Preterm Birth…” by Tracy A. Manuck, MD, points out that a woman’s cervical length is not checked until 18-22 weeks gestation. The age of viability for pregnancy is at the very least defined at 24 weeks gestation. This gives clinicians only 2-6 weeks to act on the discovery. This is exactly what happened to be in my second pregnancy. I was almost 19 weeks when they discovered the shortening of my cervix, and what was left went so quickly that I would be rushed to a top NICU hospital for hospital bed rest and a rescue cerclage. The only symptoms I had were the normal aches and pains of pregnancy, or so we thought.
With cervical insufficiency being a silent threat, it would seem fairly logical step to provide or at least offer women a chance at early cervical screenings. Every woman is different, every womb, every pregnancy. A woman’s first pregnancy could seem textbook normal and then her second is high risk. We don’t know. There is no perfect formula to tell us which women are at risk, which babies are not going to make it to term.
What we do have is plenty, of not speculation, but actual studies saying that about 20% of 2nd-trimester miscarriages are attributed to cervical insufficiency. I may not be great at math but I do know that for the number of pregnancies and unfortunately, miscarriages happening every year, 20% of women having to go through that kind of trauma and loss is too many when we have a clear solution that could cut down on that percentage. Early intervention could be the key to providing proper resources and support for these women.
In the article by Dr. Manuck, (page 2) one study estimated that up to 6500 babies a year could be saved if a cervical cerclage was offered to the 8% of women with previous premature births and a shortened cervix. [1] With offering early cervical screenings we could have the shortened cervix documented for these women BEFORE they experience a loss AND offer them a better solution then “take some progesterone and we’ll check you every week.” While that approach can be effective for some women, it’s not a fix-all solution and we come back to the fact that every pregnancy is different. Progesterone did nothing to salvage what was left of my cervix within the week of using it before my check. By the time my weekly ultrasound came, my cervix was almost completely diminished.
Berghella and colleagues estimated that, if a cervical cerclage were offered to the 8% of women with a prior spontaneous PTB and a cervical length of less than 25 mm, more than 6,500 newborns would be saved each year from perinatal death associated with prematurity.[1]
So if we take a look at the fact that 1 in 100 pregnancies are diagnosed with incompetent cervix issues and this statistic does not account for first trimester losses (true cervical insufficiency can’t be dianosed until the second trimester but cervical weakness can be diagnosed early)…doesn’t that just give us more of a reason to offer these women a hope at early detection? Cost analysis has shown it’s cost-effective [2][3] but sadly the truth here is it hasn’t been studied enough. We don’t know how effective at detecting premature birth risk and there’s a lot of high-risk pregnancy complications that need research and resources. Knowing that is, in fact, cost-effective though leaves us women who have suffered through this condition with even more questions than before. Why are our lives and our babies’ lives not important enough to care about? Would researching this further really not be worth it?
This is where our tag line “too rare to care” comes into play. This awareness campaign is so very important to women across the world because even clinicians don’t have all the facts they need to properly diagnose and support women with cervical insufficiency. By building awareness, we can get the right resources into the hands of health care providers and families to create a community of support for everyone who is struggling with incompetent cervix. It doesn’t just affect the women, but everyone in their own village. A loss is a loss no matter what, and if we really want to say that life begins with the heartbeat, we need to start protecting that heartbeat long before the issue arises.
Reference:
Berghella V, Keeler SM, To MS, Althuisius SM, Rust OA. Effectiveness of cerclage according to severity of cervical length shortening: A meta-analysis. Ultrasound Obstet Gynecol. 2010;35(4):468–473.
2. Werner EF, Han CS, Pettker CM, et al. Universal cervical-length screening to prevent preterm birth: A cost-effectiveness analysis. Ultrasound Obstet Gynecol. 2011;38 (1):32–37.
3. Cahill AG, Odibo AO, Caughey AB, et al. Universal cervical length screening and treatment with vaginal progesterone to prevent preterm birth: A decision and economic analysis. Am J Obstet Gynecol. 2010;202(6):548.e1–e8.
