The patient

A routine ultrasound at 20 weeks’ and four days’ gestation showed cervical insufficiency. A pelvic exam by the patient’s primary obstetrician revealed her cervix was 3 centimeters dilated, with a bulging bag of water beyond her cervix. The patient was admitted to Norton Women’s & Children’s Hospital, and a referral was sent to Norton Children’s Maternal-Fetal Medicine.

The challenge

Women with cervical insufficiency usually lose their pregnancy before viability between 18 and 23 weeks’ gestation. This patient was at very high risk for rupturing membranes with delivery of a nonviable baby or an extremely premature baby as well as infection with possibility of uterine/fetal infection and maternal sepsis/death.

The provider

Helen Y. How, M.D., maternal-fetal medicine specialist with Norton Children’s Maternal-Fetal Medicine

The solution

Patient was seen immediately, and after appropriate observation, lab work and extensive counseling, patient opted to proceed with rescue cerclage two days after the routine ultrasound and one day from completing her 21^st week of gestation.

The result

The rescue cerclage delayed delivery until 39 weeks and two days. The patient delivered a healthy 8-pound, 6-ounce baby by cesarean section because of a breech presentation.

Treatment and results may not be representative of all similar cases.