GYN CHRONICLES
Cervical Incompetence
And The McDonald Stitch
Dr. Maureen Owiti
R
ecently, I had an interesting day. I
was doing a Caesarean section late
in the evening when a friend of
mine called that his wife was having some
bleeding issues and he was very anxious.
The wife was in her second trimester and
had recently had a McStitch as we call the
McDonald stitch in short with a different
colleague.
My antennas immediately went up and
I advised them to rush to hospital as
any bleeding in pregnancy is a medical
emergency. God was kind that night (as
always), as Ultrasounds done revealed the
baby was fine and there was no evidence of
abruption (placenta peeling off the uterine
wall) or a placenta praevia (placenta lying
at or near the cervix).
Pelvic examinations revealed that there
was no active bleeding or any lesion on
the cervix or vagina that could cause the
bleed, so we put the mother on strict bed
rest. What could be causing the bleed?
Hhmm I wondered?!!!! Could this be a
rare case of vellamentous insertion of the
cord (when the cord inserts itself into the
membranes of the amniotic sac instead of
the placenta).
After racking my brain a little I decided
hey there are feto-maternal specialists; so
I asked the patient to have a repeat scan
done by the specialist and fortunately
there was no vellamentous insertion
but an indication that the stitch may be
causing some inflammation on the cervix.
So what caused all this drama on a
wonderful Friday evening making me
resist the soulful pleas of my daughter
(Mama… are you coming home?!!!)
This was indeed a complication of the
stitch so I put the mother on paracetamol,
some antibiotics and medication to relax
the uterus some progesterone. I have my
Cervical incompetence is when the cervix is
weak and starts to thin out (effacement) and di-
late prior to full maturity of the baby. This can
cause a miscarriage or preterm birth. The typ-
ical history is that the patient has painless dila-
tation of the cervix and usually loses the preg-
nancy in the second trimester.
56 MAL24/18 ISSUE
fingers crossed with hope she does well for
the remaining of the pregnancy.
The initial reason for the stitch was because
of cervical incompetace. Cervical what?
You may ask. Cervical incompetence
is when the cervix is weak and starts to
thin out (effacement) and dilate prior to
full maturity of the baby. This can cause a
miscarriage or preterm birth. The typical
history is that the patient has painless
dilatation of the cervix and usually loses
the pregnancy in the second trimester.
Cervical incompetence occurs in about
1-2% of all pregnancies however is
responsible for between 20-25% of all
miscarriages. This is a very big burden and
many women have suffered terrible loss
because of this.
Risk factors for cervical incompetence
include: diagnosis of cervical weakness in
a previous pregnancy; previous preterm
premature
rupture
of
membranes;
history of conization (cervical biopsy);
diethylstilbestrol (drug used for prevention
of recurrent miscarriages, that is no longer
used) exposure, which can cause anatomical
defects of uterus and vagina; and uterine
anomalies.
Treatment for cervical incompetence
can be medical/conservative but more
frequently cervical cerclage (stitch).
Cerclage is when the cervix is closed or
tightened with the aid of a stitch or tape