Miscarriage: Treating Cervical Insufficiency

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Guest: Dr. David E. Soper - Obstetrics and Gynecology

Host: Dr. Linda Austin. – Psychiatrist

Dr. Linda Austin: I am Dr. Linda Austin. I am interviewing Dr. David Soper, Professor of OB/GYN at the Medical University of South Carolina. Dr. Soper, you are doing some very interesting work on treatment for a condition called cervical insufficiency, what is that condition first?

Dr. David E. Soper: Linda, cervical insufficiency used to be called incompetent cervix and essentially a woman that have a cervix that cannot bear the pressure of a normal advancing pregnancy and unfortunately they end up losing pregnancies in the second trimester, so after 16 weeks, but usually before 22 weeks. This is of course very emotionally difficult for the patient and we found that we can actually put a stitch around the cervix to prevent this. The stitch most of the time can be put in just by visualizing the cervix through the vagina, but occasionally we have patients that actually require the stitch to be put in the abdominal cavity.

Dr. Linda Austin: So, if a woman has had one miscarriage for that reason, one loss of pregnancy for that reason, is she likely to have subsequent experiences with losing pregnancies in the middle trimester?

Dr. David E. Soper: Yes, and once she has had a mid-trimester loss and you have a diagnosis of cervical insufficiency, you become a candidate for vaginal cerclage. Now, the patients that fail vaginal cerclage become candidates for abdominal cerclage, and I am really happy to report that here and not very -- many other places in the country frankly, but here we are able to do laparoscopic placement. What that means is instead of making an incision in the abdomen, that we are able to essentially place a telescope beneath the bellybutton, visualize the cervix and the uterus, and be able to put this stitch around the cervix inside the abdomen and prevent those kinds of pregnancy loses even that occurred despite vaginal cerclage.

Dr. Linda Austin: I am envisioning this as being like a drawstring on a purse, is that exactly what it looks like?

Dr. David E. Soper: That’s exactly what it looks like and the suture that we use is a band, so it’s thicker than the normal suture.

Dr. Linda Austin: Now, when a woman goes into labor, can she have a normal vaginal delivery or does that lead to a cesarean section?

Dr. David E. Soper: In patients that have had vaginal cerclage, we are able to visualize the stitch and cut it out to allow vaginal delivery, but in women who have had the abdominal cerclage placed, we have to do a cesarean delivery, but the good news is if they want a subsequent pregnancy, they can use the same stitch for a subsequent pregnancy, we don’t have to remove them.

Dr. Linda Austin: Very exciting research, how many women to date have had that procedure here?

Dr. David E. Soper: We have done 18 women with laparoscopic cerclage and we are right now looking at our information comparing them to the old way that this used to be done and even though we are not done with the analysis I can share with you that it looks like the outcomes are the same. It’s not perfect, but women can expect instead of essentially in a 100% failure, about 80% success rate once laparoscopic cerclage is put in.

Dr. Linda Austin: Now, is this going on as a clinical trial or is this a standard regular clinical procedure at this point?

Dr. David E. Soper: It’s a standard procedure at this point.

Dr. Linda Austin: Dr. David Soper, this is fantastic work, which you are doing; keep it up.

Dr. David E. Soper: Thank you.

Dr. Linda Austin: Thank you very much.

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