Doctors Lounge - Gynecology Answers
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Forum Name: Obstetrics
|kempjesusfreak - Sat Apr 18, 2009 7:20 pm||
I gave birth to my baby on the first day of her 22 week, therefore she did not survive. At my follow up visit my doctor said that most likely it was from an incompetent cervix. If I had visited him four days earlier shouldn't he have seen that my cervix was dilated more than normal? How is an incompetent cervix determined? Also, I had went to the emergency room because I was having pains, contractions, that were about 4 minutes apart. They put a monitor on me for a while. Then sent me home. The nurse told me that it was probably my uterus stretching and told me to take some tylenol. However, I was in labor. I went home and went to the bathroom and almost had my baby in the toilet. I felt her head in the opening of my vagina and sucked her back in. Could the delivery have been postponed if the nurse would have not sent me home the first time. By the way, I never had any blood or spotting until the second time I went to the hospital.
|Debbie Miller, RN - Fri Apr 24, 2009 4:21 pm||
I am so sorry for your loss. This can be devastating. Having experienced a late term stillbirth myself I understand how desperately you are searching for answers and reassurance this will not happen again, as well as knowing nothing more might have been done to avoid this tragedy.
Unfortunately the most usual way that incompetent is diagnosed is when a situation like yours occurs. A loss in the second trimester is always suspicious for incompetent cervix and in the first one, it can usually not be averted. But, even after the fact we don't necessarily mean it was the definite cause.
Since now there is this possibility your doctor will consider you at risk for it in a future pregnancy and will likely do ultrasonic cervical measurements as you go along. This is not done routinely in pregnancy because incompetent cervix is unusual and risks associated with internal exams would exceed benefits obtained if it was done across the board. If it appears your cervix is shortening or even just as a general precaution, in a future pregnancy, your doctor may offer a cerclage (sometimes called a "stitch" in the cervix) usually done during the second trimester.
There is no guarantee this will prevent a future early delivery but it can help in many cases.
In your situation it is unlikely anything more could have been done to prevent the early delivery, but had they sent you to the labor and delivery area, they would have been able to determine that you were actually in labor, that your cervix was dilating and you could have delivered in a more appropriate setting. Of course you would still be grieving and frustrated but at least you would have been attended for the birth.
Most obstetric protocols advise the mother to go directly to L&D if they have an emergency, bypassing the ER altogether if they are at least 20 weeks along.
If you need help with dealing with your loss, please seek therapy for this. It can affect you seriously.
Good luck in your future.
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