Kofinas Perinatal: Maternal-Fetal Medicine High Risk Pregnancy
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Frequently Asked Questions
As a physician practicing for over 20 years, I have encountered countless questions and have heard infinite concerns from mothers and their families about everything from smoking during pregnancy to what sort of music may or may not be harmful to the development of a baby’s ears. Hopefully, going through this list will ease some of your worries, or in the least inform you as to what you should and should not be concerned about. - Alexander D. Kofinas, MD

» Premature Labor

» Incompetent Cervix

» Pregnancy Loss

» Nutrition & Exercise

» Thrombophilia

» Fetal Monitoring

» Meds and Supplements

» Cerebral Palsy

» Medical Conditions

» Miscellaneous


What does the term "incompetent cervix" imply?
Incompetent CervixCervix:
The lower part of the uterus extending from the isthmus of the uterus into the vagina.  is a condition where the CervixCervix:
The lower part of the uterus extending from the isthmus of the uterus into the vagina.  shortens and then dilates early in the pregnancy. This leads to either pregnancy loss (spontaneous abortion in the second trimester) or an extremely premature delivery of less than 34 weeks gestation. This loss occurs with no traditional signs or symptoms of premature labor. Patients who suffer from incompetent CervixCervix:
The lower part of the uterus extending from the isthmus of the uterus into the vagina.  can still achieve successful term pregnancies with the placement of a CerclageCerclage:
The placement of a nonabsorbable suture around a functionally incompetent uterine cervix. , which can then be removed at the proper time.
What is the cerclage?
Cerclage is a procedure in which a SutureSuture:
The fine thread or other material used surgically to close a wound or join tissues.  (stitch) is placed around the CervixCervix:
The lower part of the uterus extending from the isthmus of the uterus into the vagina.  in a purse-string fashion with the intention of keeping the CervixCervix:
The lower part of the uterus extending from the isthmus of the uterus into the vagina.  closed and thus sustaining the pregnancy. Most Obstetricians today use the Macdonald type of removable SutureSuture:
The fine thread or other material used surgically to close a wound or join tissues. , and when the pregnancy gets to term they remove the SutureSuture:
The fine thread or other material used surgically to close a wound or join tissues.  to allow for vaginal delivery. A permanent type of CerclageCerclage:
The placement of a nonabsorbable suture around a functionally incompetent uterine cervix.  is the Shirodkar type of CerclageCerclage:
The placement of a nonabsorbable suture around a functionally incompetent uterine cervix. , which when successful, is left in place for future pregnancies. Today, this has fallen out of favor and the vast majority of Obstetricians use the Macdonald type. The procedure is usually outpatient, lasting only 10-15 minutes and performed under spinal anesthesia.
I lost two babies because of cervical incompetence and was told I needed an abdominal cerclage. Is this correct?
No, this is not correct. At KOFINAS PERINATAL we have shown that abdominal CerclageCerclage:
The placement of a nonabsorbable suture around a functionally incompetent uterine cervix.  belongs in the history books and not in the operating room. The only exception is when the CervixCervix:
The lower part of the uterus extending from the isthmus of the uterus into the vagina.  is not accessible for any reason through the vagina and the diagnosis of incompetent CervixCervix:
The lower part of the uterus extending from the isthmus of the uterus into the vagina.  is certain. We have treated a large number of patients who were referred to us originally for abdominal CerclageCerclage:
The placement of a nonabsorbable suture around a functionally incompetent uterine cervix.  due to multiple prior losses despite the use of conventional CerclageCerclage:
The placement of a nonabsorbable suture around a functionally incompetent uterine cervix.  in their previous pregnancies. These patients achieved the desired number of successive term pregnancies with proper management of cervical incompetence and PretermPreterm:
Occuring or appearing before the expected time at the end of a full-term pregnancy.  labor and without abdominal CerclageCerclage:
The placement of a nonabsorbable suture around a functionally incompetent uterine cervix. . At least three randomized clinical trials have shown that CerclageCerclage:
The placement of a nonabsorbable suture around a functionally incompetent uterine cervix.  alone has always failed to improve pregnancy outcomes in patients with short CervixCervix:
The lower part of the uterus extending from the isthmus of the uterus into the vagina. . It is the obstetrician/perinatologist who fails to realize that most patients with second trimester losses suffer from a mixture of cervical weakness and premature labor. Unless both problems are addressed, the pregnancy will fail again and again.
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