It is very rare to miscarry in the second trimester. Cervical incompetence is a rare condition that can cause second trimester pregnancy loss. Cervical cerclage is a procedure that treats cervical incompetence.
Almost all miscarriages happen in the first trimester. Once the heartbeat is heard in the office, usually at 10-12 weeks, it is very rare to lose the pregnancy. This is a good time to tell people that you are pregnant since it is unlikely that you will not be having a baby now that you made it to the second trimester.
Cervical incompetence is an unusual condition that can cause second trimester pregnancy loss. Cervical incompetence happens when the cervix is not strong enough to hold the baby in. As the baby grows and pushes against the cervix, it can cause the cervix to dilate and the baby will deliver. When cervical incompetence occurs, it usually happens around 18-22 weeks and the baby is too small to survive. Risk factors for cervical incompetence include multiple abortions, second trimester D&E, previous surgery to the cervix such as cold knife cone, or past history of cervical incompetence. Most cervical incompetence is in women with no risk factors.
Cervical incompetence does not usually present until it is too late to treat. Some women will notice a change in discharge with a sudden increase in vaginal discharge. Increased vaginal discharge is common at this stage in pregnancy due to the increased hormones and is usually not do to a problem. Women may also experience increased pelvic pressure but again, this is a common symptom of normal pregnancy as well.
The treatment for cervical incompetence is called a cervical cerclage. A cerclage is a stitch that is placed around the cervix to make a “purse string”. This is tied down to increase the strength of the cervix. This is typically done in the operating room and can be done under spinal anesthesia. The procedure is fairly simple and very safe. Women with cervical incompetence will also be placed on bed rest as well as pelvic rest. Pelvic rest means nothing in the vagina, no sex, tampons, etc.
Women with a past history of cervical incompetence are often given a prophylactic cervical cerclage. This is place usually at 14 weeks before any signs of cervical incompetence develops in the current pregnancy. These tend to work very well and most women go on to have full term healthy babies. The cerclage is typically removed around 37 weeks, this can be done in the office and does not hurt.