Erica Holden was in the second trimester of pregnancy with a son when she went into labor and delivered the baby stillborn in April 2017. “My doctors at the time said it was a rare occurrence, that maybe there was an infection in the placenta or amniotic sac,” says Erica, a 29-year-old from Finneytown. “I had never even heard of cervical insufficiency.”
In September 2017, she got pregnant again, and once again lost the child in her second trimester. She was in the ER at TriHealth’s Good Samaritan Hospital when William Schnettler, MD, an OB-GYN with TriHealth’s Tri-State Maternal Fetal Medicine Associates came to speak with her. “He asked me some questions and pretty quickly said he thought it was cervical insufficiency,” says Erica. “He was able to confirm that diagnosis in a matter of minutes with an ultrasound.”
Dr. Schnettler explains that cervical insufficiency happens when a woman’s cervix isn’t able to hold a baby inside the womb as it starts to grow, which often results in preterm labor and loss of the baby around the second trimester. Cervical insufficiency is a condition that a woman can be born with. It can also result from previous medical procedures like cervical biopsies or surgery.
“Unfortunately, many women with cervical insufficiency aren’t diagnosed until after they’ve lost two or three children,” says Dr. Schnettler. “The emotional damage of that is very real. These are expecting mothers who have already told their families, learned the child’s gender, and started thinking about names.”
Dr. Schnettler hopes to change that with a new Pregnancy Loss Prevention Program aimed at both researching ways to diagnose the condition before multiple losses occur and offering a solution—a procedure called cerclage—that can help these women have healthy, full-term babies.
Reinforcing The Cervix
Cerclage is a relatively simple procedure in which the cervix is reinforced with a band or sutures (stitches) to prevent early loss of a pregnancy. The procedure can be done before or during pregnancy. The most common form of cerclage is performed through the vagina; however, there are also methods for doing the procedure surgically through the wall of the abdomen. As director of TriHealth’s Trans-Abdominal Cerclage program, Dr. Schnettler is one of only a handful of doctors in the country who offer minimally invasive trans-abdominal cerclage using a da Vinci surgical robot.
After she was diagnosed with cervical insufficiency, Erica continued seeing Dr. Schnettler. “He explained that we had three options,” says Erica. “The first was to do nothing and monitor everything really closely if I got pregnant again. The second was trans-vaginal cerclage, which he said is about 90 percent successful. The third option was trans-abdominal cerclage using the robot, which he said has a 99 percent success rate.”
After discussing it with her husband, Jarrel, Erica opted for the robotic surgery. “The procedure was very simple, and I was back to work within a few days,” she explains. “Now I feel so much better mentally and emotionally knowing that we’re prepared if I get pregnant again. And I will definitely have Dr. Schnettler care for my next pregnancy.”
Emphasis On Awareness
Current estimates of how many women experience cervical insufficiency are around 4 percent, and an important goal of Dr. Schnettler’s Pregnancy Loss Prevention Program is finding better ways to screen and identify women who may have the condition before they lose a child. A big part of that early diagnosis is simply awareness, both among women and their doctors, of the risk factors that can lead to cervical insufficiency.
“The early signs haven’t really been fleshed out in medicine, so we’re doing research and looking for diagnostic methods to find it before these tragic losses occur,” explains Dr. Schnettler. “Right now, the best tools I have are really detailed questioning and history taking of all of a patient’s risk factors and what went on in previous pregnancies, combined with a transvaginal ultrasound to examine the cervix.”
Erica believes every woman should be aware of cervical insufficiency because it’s relatively easy to find and treat if the doctor is looking for it. “Trust your instincts. If you think something is wrong, get a second opinion from a specialist,” she says. “Who wouldn’t get this done to help ensure they have a successful pregnancy?”