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Discussion

Does this seem odd?

I was watching A Baby Story (yeah I know, not entirely accurate in it's depictions). Anyway the woman was a prime with a couple previous losses and then a cerclage. That didn't confuse me but then she was placed on bedrest for the remanider of the pregnancy. Now I can see being on bedrest for a time but full bedrest (keep in mind I work in low lisk only) until 39 weeks. I would think that as her pregnancy progressed they would have let her at the very least let her be on modified bedrest and let her off bedrest enitrely when sh ehit 34-35 weeks.

Also it was automatically a c-section. Now again I realize they edit it for a 30 minute show, I don't know her full history and it's filmed in the US where they have more primary sections but I would have thought they would have removed the cerclage at 36 weeks, as they do in Canada, and at the very least allow a trial of labour.

Does that sound accurate for where you practice?

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It sounds like there may have been a few issues that were not well explained in the episode.

As you know, a cerclage may prevent or delay the dilation of the cervix caused by mechanical forces such as the weight and pressure of the developing baby, but won't do a thing to prevent or lessen contractions which can also contribute to effacement and dilation. Keeping her on strict bedrest for the duration of the pregnancy makes me believe that she may have had a combination of incompetent cervix and preterm labor.

It seems as though the desire was to get her pregnancy to 39+ weeks, which is the standard many OBs are now aiming for to prevent inadvertent prematurity caused by a too-early planned C-section or induction.

As for leaving the cerclage in place, I think that is a matter that is determined by the technique used to place the cerclage and the desire for future pregnancies without having to undergo the cerclage each time. I have seen patients and their OBs elect to manage this both ways. Some remove the cerclage and attempt labor. Others leave it in place until the couple is finished with childbearing, removing it with the final pregnancy.

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