Friday, October 16, 2009

Incompetent cervix linked with abortion

It has long been known that two or more first trimester abortions or one second to third trimester abortion greatly increased the risk to incompetent cervix. This link has been reinforced through my nursing education and in my own small amount of research into the topic online.

What is incompetent cervix?

Sometimes the neck of the uterus, called the cervix, can be weak during pregnancy. If the cervix is too weak and becomes too thin, the pregnancy leads to a miscarriage after the 12th or 14th week. (1) However, incompetent cervix is not the sole cause of pre-term labor and it is also not something that is easily diagnosed. One treatment that sometimes is offered is cervical cerclage, a procedure in which a medical doctor sutures the cervix to help prevent miscarriage. (1)(2) Many people who are diagnosed with incompetent service are told to be on complete bed-rest (to reduce weight on the uterus and cervix) and to abstain from sexual intercourse (which can disturb the weakened cervix) among other recommendations. (1)

What leads to incompetent cervix?

The risk factors to developing the condition of incompetent cervix does not always include therapeutic abortion. However, many do. Some include surgical procedures that are also used to accomplish abortions such as dilation and curettage (D&C). The Australian medical journal O&G had an article stating the risk factors to be congenital, acquired, and/or clinical. Congenital risk factors included "biological variation, collagen disorders, Ehlors Danlos syndrome, congenital uterine anomaly, and in utero diethylstilbestrol (DES) exposure." (1) DES is "a synthetic nonsteroidal estrogen that was used to prevent miscarriage and other pregnancy complications between 1938 and 1971 in the United States." (3) Acquired risk factors included "cervical lacerations or injury post vaginal or caesarean delivery, prolonged second
stage, surgical procedures [such as] D&C [and] excisional biopsy." (1) Clinical risk factors were listed as presenting signs and symptoms to help physicians consider a possible diagnosis of incompetent cervix.

The part that I want to focus on is the "acquired" risk factors of incompetent cervix. Some risk factors in this category may have been avoidable risk factors. Cervical lacerations can occur during an induced surgical abortion and is oftentimes considered a "side effect" of even the earliest abortions (4). Procedures that must go through the cervix include a D&C. Dilation is often accomplished through hard metal rods and curettage is accomplish through large metal tools which can directly injure the cervix and even the uterus. It is known that "cervical trauma may occur and may lead to incompetent cervix," a statement that my education has repeatedly confirmed (8).

So the cervix is injured in an abortion?

Illustration of the cervix, tools are used to stabilize and dilate it.

Tenaculum is used to stabilize the cervix by grasping it on the side during a surgical abortion.

Hagar dilators commonly used to forcibly dilate the cervix during a surgical abortion. Even if laminaria (osmotic dilators) are used prior to the surgery, these kinds of dilators will still be used.

A curette. This is used for D&C associated and not associated with surgical abortions.

Abortion Procedure In-Progress

Link shows an actual abortion procedure and it's trauma to the cervix and pieces of the mutilated unborn human being. You have been warned, the pictures are very graphic.

What's the big deal?

All of this information is culminated in the following quote from eMedicine: "The most common etiologies for cervical injury are elective abortion, surgeries to treat cervical dysplasia, and injury occurring at delivery." (2) This means that more children are being born prematurely directly due to the practice of surgical abortion. Not even using non-mechanical means to dilate the cervix in a surgical abortion fully mitigates this risk. (2)

How many people have an increased risk due to abortion?

Think about the numbers. The most recent numbers regarding the amount of yearly surgical abortions in this country come from the Centers for Disease Control (CDC). The caveat, however, is that California, New Hampshire, Louisiana, the District of Columbia (DC), and New York City (NYC) do not report any abortion statistics to the CDC which dramatically lowers the total numbers of abortions in the United States. According to the CDC, there were 820,151 legal induced surgical abortions that occurred in the United States in 2005 (the number is probably over 1 million due to the exclusion of the states aforementioned). Thus, over 800,000 women are at higher risk of having incompetent cervix in the future.

Yet people get cervical lacerations from childbirth?

Yes, this is true. However, the number of people that experience true cervical injury during childbirth is very small. According the American Journal of Obstetrics, only 0.16% of vaginal childbirths resulted in any cervical lacerations. (7) Keep in mind that the cervix naturally prepares for childbirth through a long process during pregnancy and during the labor and delivery process. Induced abortion, however, is sudden and unnatural. Many people confuse cervical lacerations with vaginal lacerations during childbirth. The difference is real since it is the cervix which helps keep a woman in the pregnant state while the vagina is much more related to the actual birthing process as the birth canal.

How come I never hear about this?

I believe the reason is political. I can only pray for March of Dimes to declare the suggestion to "have fewer or no abortions to decrease the risk for pre-term labor in relation to the increased risk of incompetent cervix." I doubt that they will step into the political fray no matter how true a statement that is. I really do want people to stop thinking of abortion in terms of political correctness.

Let us pray for the women who are at risk for incompetent cervix that they may have the strength and courage to bear children. Let us pray for the unborn children whose mothers have incompetent cervix that they may be born alive and healthy. Let us also pray for health care workers to have the ability, knowledge, and willingness to care for the women and unborn children affected by incompetent cervix the best that they can.

Follow the sources that I have listed (one is extra) for further information. Of course, I do have some pro-life bias. Research all of this stuff on your own to form your own conclusion. Remember to follow the truth, always.

(1) Lo, Chern. O&G Magazine. "The incompetent cervix." Winter 2009. PDF
(2) Ross, Michael. eMedicine. "Preterm labor." Jul 31 2009. HTML
(3) Schrager, Arina and Potter, Beth. American Family Physician. "Diethylstilbestrol exposure." May 15 2004. HTML
(4) State of Alaska Health and Human Services. "Making a decision about you pregnancy: about abortion methods." Accessed on October 15 2009. HTML
(5) Centers for Disease Control. "Abortion surveillance." November 14, 2008. HTML
(6) "Incompetent cervix and pregnancy." morefocus group. HTML
(7) Melamed, Ben-Haroush, Chen, Kaplan, Yogev. "Intrapartum cervical lacerations: characteristics, risk factors, and effects on subsequent pregnancies." April 2009. HTML
(8) Langerquist SL, McMillin JL, Nelson RM, Snider KE, Davis' NCLEX-RN Success: Second Edition, F.A. Davis, 2006, Philadelphia.