Frequently asked questionsMonika Schreiber, Erich Saling and Jürgen Lüthje |
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Contents |
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Questions about self-measurement of vaginal pH value
Questions about bacteria and infections
Questions about miscarriages and preterm births
Questions about Early Total Cervix Occlusion (ETCO) |
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Questions about self-measurement of vaginal pH value |
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Why self-care in pregnancy?For most women, pregnancy is a very pleasing event. However, despite extensive prevention, too many babies are born preterm. These children often experience numerous and sometimes severe problems, immediately after birth or later in their life. Important signs and symptoms, which may result in preterm birth if not treated, can be recognized through specific examinations, which the pregnant women can apply at home by herself. These observations and examinations are part of our Self-Care-Program for pregnant women, which yields positive results since 1993. The self-care is an additional measure which complements the preventive routine examinations by the gynecologist. One of the most frequent causes of preterm births is the often unnoticed disturbance of the vaginal milieu by infectious bacteria. Normally the vagina inherits an ecological balance between several bacteria, with a predominant fraction of Lactobacilli which provides the acidic pH-value. (The normal vaginal pH-value is less than or equal to 4.4.) This natural protection hinders the spread of pathological bacteria, and so considerably reduces the risk of their advance into the uterus and their cause of preterm labor or premature rupture of the membranes, which both would lead to preterm birth. Early detection of reduced acidity (increase of pH) of the vaginal fluid, and treating the underlying causes appropriately, can often reduce the risk of preterm birth. However, the result of the pH-value measurement alone does not determine whether there is an infection or not. In order to recognize changes in vaginal acidity early on, women who participate in the Self-Care-Program measure the vaginal acidity (pH-value) themselves, simply and safely with a special test glove that we developed for this purpose. The index finger of the glove, with its special test area, is introduced into the vagina. The change in color reflects the acidity. With a simple comparison of the test color result with a color scale, the pH-value can be determined. If the pH-value is too high (reduced acidity) in two subsequent checks, then the pregnant woman should visit her gynecologist, in order to find out the cause, and to treat it if necessary. The instructions for use of the test gloves explain in detail how to apply them, and also inform the pregnant women about certain warning signs. If any of these signs are present, she should make an appointment with her doctor at the earliest possible moment. |
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What should be done if pH-values are raised?Question: Do I have to see my physician immediately if the if the pH-value is raised? Answer: If the pH-value is not normal once, there is no reason for anxiety. It could have been changed, for example, after coitus through the seminal fluid. This is why the pH-value should not be measured within 12 hours after intercourse, unless you have used a condom. The indicator paper also could have come into contact with urine (urine can have many different pH-values), with sweat or with water. In this case, please repeat the measurement after a suspicious result and a few hours later or the next morning. If the pH-value still is not normal, it does not necessarily mean that you already have an infection, but you should see your physician as soon as possible to find out the cause for the increased pH-value. Only a few of the approx. 10 000 women who took part in our program, have reported, that they had always increased pH-values, without finding a reason for that. This phenomenon must be examined further by studies, which is rather difficult, because it is a very rare event. In some women the reason could be that there is an increased secretion of mucus from the cervix which causes a neutralisation of the lactic acid. If you have an increased pH-value but your physician has confirmed adequate lactobacilli numbers, and you show no signs of infection or pain, there is no reason for anxiety. |
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Infection in spite of a normal pH-valueQuestion: I was informed of the diagnosis of a vaginal infection, though the pH-value was always normal. How reliable are the gloves? Answer: With the gloves you measure only the pH-value and do not examine whether you have an infection or not! If the vaginal fluid is acidic enough, that means
that there are enough lactobacilli. These bacteria support
(through producing lactic acid and for instance hydrogen
peroxide) the immune system against other, possible pathogen
bacteria. Because many of these bacteria do not grow well in this
environment. Besides the regular pH-value measurement you should take care of other danger signals, which are described in our Self-Care-Program info material. |
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Premature rupture of the membranes and pH measurementQuestion: Can one determine a premature rupture of the membranes with the pH measurement? Answer: During a premature rupture of the membranes the amniotic fluid withdraws from the uterus into the vagina. The amniotic fluid is clearly more alkaline in comparison to the vaginal fluid (acid). The pH values in the vagina rise to approx. 7.0, which corresponds to the blue color on the color scale of the test gloves. If however there is only a small tear of the membranes and the amniotic fluid only spotting, the vaginal pH value may change only a little or not at all. |
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Color of the test areaQuestion: I often had problems comparing the colors: I couldn't find the color of the test area on the color scale. Isn't it possible to improve the color scale? Answer: The color scale on the glove package shows the colors, which the test area has at pH-values 4.0 - 4.4 - 4.7 - 5.0 - 5.3 - 5.5 - 5.8 - 7.0. The (normal) values 4.0 and 4.4 correspond to yellow/beige, at 4.7 the color begins changing to brown, and at 7.0 the color is dark blue. A color scale is always a compromise. If the color of the test area is e. g. between the colors that correspond to pH 4.7 and 5.0, then the pH-value corresponding to the color which is most similar to the color of the test area should be chosen. The pH-value 7.0 might indicate rupture of the membranes, or another severe disturbance. A color of the test area which is light yellow (i.e. more light than the color corresponding to pH 4.0) is of no concern: It indicates a pH-value somewhat lower than normal, which is not known to cause problems. |
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Localisation of the test areaQuestion: Why isn't the test area at the tip of the index finger? Answer: The measurement is to be performed about 2–3 cm from the introitus of the vagina, not too close to the cervix, because the cervical mucus is rather basic, and could tamper the measurement. |
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AllergiesQuestion: I am allergic to Latex. Can I use the test gloves anyway? Answer: In contrast to several other plastics gloves, the test gloves do not contain Latex. Apart from the small test area, they consist completely of polyethylene (PE), which has a very low risk to cause an allergy. Eliciting hypersensitivity to the pigments on the test area is also unlikely, since these are bound very tightly to the paper (chemists call it “covalent bond”), and so they are not dissolved in the milieu of the vagina. |
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Why not use fingerstalls?Question: Using a whole glove for measuring seems like a waste. Why isn't the test area attached to a fingerstall instead? That would be cheaper and more environmentally friendly, wouldn't it? Answer: The gloves, to which the test area is attached, are assembled in large-scale industrial production. Using fingerstalls would be considerably more expensive. |
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Measurement with indicator paperQuestion: Why not simply measure with indicator paper, this would be much cheaper? Answer: pH-values are marked from 0 to 14. The range of pH-values which are important for the diagnosis of vaginal disturbances is very small, 4.0–4.4 is normal and more than 4.4 is already conspicuous (if the values are measured by a pH-meter, therefore more exactly, values more than 4.2 are already conspicuous). Many pH papers are showing in this area only slight small color alteration, for example, olive-green to slightly small darker olive-green. Comparing the colors would be near to possible mistakes or even completely impossible. Litmus paper for example differentiates only pH-values greater or less 7.0. |
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My physician discourages from pH measurementQuestion: My gynecologist advised against participation. He said the measurements are not beneficial for me and would worry me, and aside from that, regular medical controls are sufficient. Answer: The most important in the pregnant woman care are regular medical controls. Thus disturbances often will be noticed in time. But in the first two thirds of the pregnancy, you usually go only once per month for a preventive medical examination. The self care program for pregnant women with the twice weekly measurements of the vaginal pH value provides an additional protection. This way disturbances of the vaginal environment can be recognized (and if necessary treated) incomparably faster as it is possible by the medical standard check-ups. The success of this additional measure is shown by our results as well as the ones from Prof. Hoyme and others. Some physicians demand so called “randomized controlled trials” for proof of efficacy. In a randomized trial, some of the participants will be assigned to the treatment group, while the others will be assigned to the control group. However, Prof. Saling is convinced that it is not ethically justifiable to withhold about each second woman (the women in the control group) from treatment in case of increased vaginal pH values. In the meantime results of a German health insurance company (KKH) exist that with their insured women who made pH self-measurements, the rate of very early born children was more than 40 % lower. The presumption of your physician that the measurements lead to an unnecessary uneasiness is not founded. When we asked 758 women who participated in the self care program, 94 % of them found the measuring procedure simple and not stressful. 99 % judged the measure as meaningful and/or had the feeling to do something useful for themselves and their child. Some women wrote expressly, how reassuring they found the measurements. Perhaps you speak again with your physician and give her/him our internet address; s/he is also welcome to contact us. Another reason why some physicians are against the vaginal pH measurement is the concern that germs could displace upwards by the measurement. (see “Contamination with germs through the measurement?”) |
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Meeting the costs by the health insuranceQuestion: Why aren't the costs of the gloves accepted by the health insurance? Answer (regarding the situation in Germany): The benefits which the health insurance may provide for the insured are legally regulated. A health insurance may not refund costs of a certain treatment or measure, only, if this is specified in the service catalog. Before new measures or treatments (like the self care program for pregnant women or e. g. acupuncture) can be financed by the health insurance, the federal committee of the physicians and health insurances must examine this. But the new measures can be used as model projects for a test. The health insurance concerned must place a request at its supervisory authority and the project has to be evaluated scientifically. After conclusion of the model project the scientific results are transmitted to the federal committee of the physicians and health insurances for examination. In the past years the health insurances accomplished several model projects regarding the self care program for pregnant women developed by Professor E. Saling. If necessary, it is advisable to inquire your health insurance. |
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Questions about bacteria and infections |
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What are “Lactobacilli”?Question: What are “Lactobacilli”? Answer: It would be better to use the term lactic acid producing bacteria. Simplifying we often talk of “lactobacilli”. This is a big group of bacteria, which produces lactic acid. Some of these bacteria are, for example in dairy products, or they live normally in the digestive tract and vagina. Lactobacilli are the largest group of bacteria living in the vagina and maintain the acid milieu through the production of lactic acid. This acid stops the increase and the activity of many other bacteria, even those, which are possibly responsible for an infection. Beside the lactic acid the lactobacilli often produce other substances, like oxygen and hydrogen peroxide (H202), which also have a stopping effect on the other bacteria. |
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Prevention with Lactobacilli?Question: Could I take preventive preparations with lactobacilli or acidifying substances? Answer: We would rather advise not to use a self therapy with compounds of lactobacilli or those to acidify the pH-value. As long as your vaginal pH-value is normal and your physician does not see by microscope something conspicuous in the wet smear, you can be sure that lactobacilli are present in a sufficient number. Then there is no need to take acidic compounds or lactobacilli. If on the contrary the pH-value is suspicious, it is indeed necessary to find out the cause. Regularly taking acidic compounds would result in possibly “normal” pH-values, without the real cause having been found. |
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Contamination with germs through the measurement?Question: My gynecologist has advised me not to participate, because he thinks that by using the gloves it could be that germs could be brought into the vagina. How can I avoid the risk or could you guarantee that the gloves are free of germs, if I handle them correctly? Answer: The gloves are packed hygienically for one time use. Additionally, before inserting the gloved finger, you should spread the labia with the other hand. Intercourse is much more “dangerous” to introduction of critical germs or procrastination of germs, because there are a number of them present in the penis are settled with them and because of this despite that women are advised not to have coitus during pregnancy. Also the vagina is not free of germs but there is mostly a balance between the protective lactobacilli (which keep the milieu acid) and other germs that could be responsible for an infection. During the coitus (even if you use a condom) or also during a medical vaginal examination with palpation of the cervix, there is the possibility of bringing in germs from the entrance of the vagina into the cervix. With the gloves you measure only at the entrance of the vagina (about 2–3 cm deep). The results of our experiences have shown that there is hardly a risk of contamination of germs. The results also show that by using the gloves there is no increase but rather a decrease of the number of preterm births! It is also important to emphasize again, that with the gloves you only measure the pH-value and do not test for an infection. Furthermore, an acidic vaginal pH-value does not give protection against all possible infections (see question: “Infection in spite of normal pH-value?”). |
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Recurrent vaginal infectionsQuestion: I often have vaginal infections, which were treated with suppositories and antibiotics. What else can I do? Answer: Infections in general and
especially vaginal infections can be increased in pregnancy by
hormonal changes as well as by other circumstances. For example,
a warm moist climate can encourage the growth of Candida. If there are frequent vaginal infections of fungi and bacterial vaginosis, a local disinfecting treatment with an Octenidine preparation could be better than a systemic treatment with antibiotics, because it would lessen the disturbance of the intestinal flora. Women with lactobacilli which produce hydrogen peroxide (H2O2) have a slighter less risk of getting to get a bacterial vaginosis than women with lactobacilli without producing hydrogen peroxide. In case of frequent vaginal infections it could be helpful to have a special lab test (text in German) to identify treatment options. If there is frequent bacterial vaginosis, a
prophylactic measure could also be a so called “vaccination”
with Gynatren® or SolcoTrichovac®. This affects only
abnormal lactobacilli and does not harm the normal lactobacilli;
on the contrary the healthy flora recovers. We were able to achieve
a decrease of recurrence in many women, but some women did not have a
satisfying reaction to these drugs. |
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Bacteria in the urineQuestion: My gynecologist discovered bacteria in the urine and therefore prescribed an antibiotic. However, I have no discomfort. So is this not an unnecessary exposure to antibiotics? Answer: By no means. An infection of the urinary tract during pregnancy – even if the infection does not give any troubles at all – could become critical for the mother and the child. On the one hand, the germs from the bladder ascend more easily over the urethras into the kidneys since the urethras – hormonal caused – are sometimes expanded during pregnancy. This could lead easily to pyelonephritis. On the other hand, the risk of a miscarriage or preterm birth is definitely increased with infections of the urinary tract – and is also valid regarding infections which cause no trouble yet. Therefore the urine is examined regularly on preventive medical examinations, and treated with an antibiotic if necessary. |
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Examination for vaginal infections prior to pregnancyQuestion: Caused by an infection, our baby was born preterm last year. We plan a new pregnancy. Someone told me to check for infections before the next pregnancy. How do you think about that? Answer: Yes this could be quite meaningful, because studies have shown that preterm births happen more often the earlier in the beginning of the pregnancy the disturbance of the vaginal fluid is present. In addition far more different antibiotics can be used before a pregnancy, whereas when being pregnant only some are applicable (see also “antibiotics in pregnancy”). Of course you have to check during the pregnancy regularly also. Beyond that an Early Total Cervix Occlusion could be indicated, if miscarriages or preterm births have already occurred in the past. Please discuss this with your gynecologist. |
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Antibiotics in pregnancy?Question: I am in the third month pregnant, and my physician prescribed an antibiotic. I am concerned that it may harm the child. Answer: Actually, in the pregnancy caution is required regarding medicines. One has to weigh the possible risk for the child against the use of the medicine and/or the possible danger if it is not taken. Basically antibiotics – in particular during pregnancy – should not be taken too generously (never in cases of trifle) because the vaginal and intestinal flora can be affected and therefore the immune situation impaired. However, in many cases it is necessary to take antibiotics and there are some (e. g. penicillin) which have been used during pregnancy for many years used without references to a possible harm on the child. If you informed your physician about your pregnancy, s/he will select an appropriate medicine for you. When in doubt please check with her/him again. |
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Questions about miscarriages and preterm births |
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Miscarriages at the beginning of the pregnancyQuestion: I already had 2 miscarriages. One during the 8th and one during the 10th week of pregnancy, but for neither one nor the other a cause could be determined. Should I measure the vaginal pH value during my next pregnancy? And what about an Early Total Cervix Occlusion? Answer: Miscarriages before 12 completed weeks are called “early” miscarriages. They are rarely caused by infections, but there are usually different causes, e. g. that the child would not have been able to live (chromosomal causes), hormonal disturbances, or anatomical changes in the uterus (e. g. adhesions). Many women have an early miscarriage (often completely unnoticed, the menstruation just seems to be late) and often no cause can be determined. Most of these women can get a healthy child in the next pregnancy without a problem. When early miscarriages occur repetitively (2–3 or more times), an examination to make out the cause should definitely be done. An Early Total Cervix Occlusion does not help in these cases, since it protects from preterm births caused by infections in the first place (also, this method is only accomplished after 12 weeks of pregnancy). Even if a cause for the early miscarriages would be found and treated adequately, you should measure the vaginal pH value during your next pregnancy in any case, so it will not come to disturbances by vaginal infections in the later process of the pregnancy. We generally recommend all pregnant women to participate in our self care program for pregnant woman. |
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Preterm birth despite pH measurementQuestion: I had a preterm birth, although the pH-measurements (which I had consequently done) always had normal results. Answer: Preterm birth can have various reasons, e. g. a replacement of the placenta, the HELLP syndrome (a very heavy form of preeclampsia, previously known as pregnancy toxemia), vaginal infections or also untreated urinary tract infections. With the regular vaginal pH measurement you detect signs of disturbances of the vaginal environment, whereby you can recognize a vaginal infection in time or even prevent it. Unfortunately, you do not recognize all vaginal infections (see “Infection in spite of normal pH value”) with the pH measurement, and it neither helps against other causes of preterm birth (see above). Nevertheless you should check the vaginal pH value in your next pregnancy again. The measurements are a very useful additional protection to the regular medical preventive examinations. If (despite pH measurement) a vaginal infection was determined as cause of the preterm birth, or if no other cause was found, an Early Total Cervix Occlusion is possibly indicated for your next pregnancy. |
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Repeated preterm birthsQuestion: I had already two preterm births (26 and 23 weeks). Now I am pregnant again. Can I do something additionally besides pH measurement? Answer: In the period between 12 and 32 gestational weeks, ascending genital infections are the main cause for miscarriages and/or preterm births and lead for example to preterm labor or a premature rupture of the membranes. We recommend an Early Total Cervix Occlusion to women, who had 2 or more miscarriages and/or preterm births between 12 and 32 gestational weeks caused by infections, or when no other specific cause was determined. Ascending of germs from the vagina into the uterus is prevented by the barrier which is set by the cervix occlusion (not so by a Cerclage). After only one miscarriage and/or preterm birth in this pregnancy period one can consider a so-called “small” Total Cervix Occlusion instead of a “large” one. |
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Repetition risk of a preterm birthQuestion: How is the risk of a subsequent preterm birth? Answer: It depends. There are several different results of research, depending whether the gestational age in which the miscarriage and/or preterm birth took place was considered, or whether it was differentiated between “spontaneous” preterm births and induced ones. Therefore we can give only some general data: Already after one miscarriage and/or preterm birth in the past, the risk is clearly increased in the next pregnancy. E. g. Professor Künzel found (1995) the following factors of risk from the evaluation of 150 591 pregnancies in Hesse:
After two preceding preterm births the risk raises substantially, for example, McManemy and staff (2007) evaluated nearly 20 000 births in Missouri, USA. The average preterm birth rate of all pregnancies was 12.1 %. If a woman had born two preceding children with more than 37 weeks, she had only a preterm birth risk of 5 % with the third child. On the other hand, women with two preceding preterm births had an average risk of approx. 40 %. The risk varied however substantially, depending on whether one or both of the preceding preterm births had taken place very early (between 21 and 31 gestational weeks), or whether the preterm births were “moderate” (between 32 and 36 gestational weeks). With two “moderate” preterm births the repetition risk was 38 %, with two very preterm births however 57 %. Other studies show some different numbers, but generally one can say that the risk of preterm births increases with the numbers and probably the date of the preceding miscarriages or preterm births. Of course one must consider the fact that these numbers are only statistic values. In individual cases also different factors must be considered, e. g. whether a remediable cause of the preterm birth exists or not. |
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Sexual intercourse as a cause of preterm birth?Question: Can sexual intercourse during pregnancy lead to preterm birth? Answer: Under normal conditions, sexual intercourse during pregnancy is no risk for a miscarriage or a preterm birth, even not in the early pregnancy. If a miscarriage or a preterm birth took place soon after sexual intercourse an ascending infection most likely was the cause, as research showed. Therefore, the use of condoms is recommended particularly for risk groups. With repetitive preterm births, or late miscarriages frequently preventively an Early Total Cervix Occlusion is accomplished. In principle after complete healing of the wound nothing speaks against sexual intercourse if no further risks are present. With other risk pregnancies it depends on the cause whether sexual intercourse can be possibly unfavorable or not. In case of doubt always ask your physician. |
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Psychological and physical burden as a cause for preterm birthQuestion: Can psychological or physical burden lead to preterm birth? Answer: Yes. Strong psychological and physical burden can increase the risk of a preterm birth. Probably by weakening the immune system, the susceptibility to vaginal or other infections increases. In addition, hormones released during stress can promote or release preterm birth. If you are employed, it is regulated by the maternity guidelines, which work you are allowed to do. In cases of doubt contact your health insurance company. In private life avoid heavy work, too (e. g. renovating, carrying heavy boxes, etc. – get help!). As long as you feel well, there is no reason however to excessively save yourself. In many cases mental burden will not be avoided so easily. Get yourself help, from relatives, friends, by an advisory board and of course from your physician. In severe cases your physician can give you a sick certificate. In particular if a couple went through a miscarriage or a preterm birth already, the next pregnancy is frequently connected with fears or at least concerns. For many couples it is helpful to be accompanied psychological during the pregnancy. Helpful can be also the communication with other parents which are in a similar situation. Nowadays, this is also possible on the internet. Provide for yourself! Especially, if you have already children, it is difficult to find time for yourself. Perhaps a babysitter, relatives or friends can take care of the children for a few hours. If you are sick, in your country there might be the possibility of getting a paid family aid from the health insurance company. A very good remedy after a stressful day is moderate exercise like walking or swimming. For all other kinds of sports you rather ask your physician who knows your health and training condition. |
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Questions about Early Total Cervix Occlusion (ETCO) |
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What is an Early Total Cervix Occlusion?Question: My last child was born despite Cerclage much too early. Now I am pregnant again and my gynecologist advised an Early Total Cervix Occlusion. What is the difference to a Cerclage? Answer: The Total Cervix Occlusion (TCO), preferably the early one, is possible for women who already had one or more late miscarriages or preterm births, where
The Total Cervix Occlusion means that the cervix is completely closed operatively. First the superficial tissue has to be removed and then the cervix is closed by stitches to afford the adhesion (contrary to the far less effective Cerclage, in which the cervix is only tightened). Ascending of germs from the vagina into the uterus is prevented by the cervix occlusion (not so by a Cerclage). With the “Early” Total Cervix Occlusion (ETCO) the operation takes place at 12 completed gestational weeks – if necessary somewhat later –, and before anatomical changes in the cervix can be recognized. |
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ETCO already after one preterm birth?Question: Can an ETCO be accomplished after one preterm birth? Answer: Yes, it is possible and to consider. Usually an Early Total Cervix Occlusion is only accomplished after two or more (infection-caused) miscarriages or preterm births, which occurred between 12 and 32 gestational weeks. Because after only one miscarriage and/or preterm birth in this pregnancy period the chances for the next pregnancy are still relatively good (however, with each miscarriage or preterm birth the risk of a subsequent miscarriage and preterm birth rises). On the other hand, one would not like to expect a woman with strong desire to have children that she must go through two preterm births or miscarriages before she receives an ETCO. We recommend the ETCO already after one miscarriage or one preterm birth, particularly, if the preceding miscarriage or preterm birth were due to a proven infection, the expectant mother is already older or additional risk factors are present (e. g. fertilisations treatment). In other cases we let the expectant mothers (and their partners) decide whether they feel safer with the ETCO in the next pregnancy. Unfortunately there still is no study whether after a preterm birth or a miscarriage a regular screening for infections (in particular the pH measurement by the pregnant woman) is sufficient in the next pregnancy, or whether a cervix occlusion leads here to better results. That we assume. This could be a solution for women with only one miscarriage or one preterm birth. Of course the risk (e. g. the anaesthesia) has to be considered in regard to the benefit. |
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Sexual intercourse after ETCO?Question: Can I have sexual intercourse after an ETCO? Answer: Generally after good healing of the ETCO (controlled by your physician) and if no further noticeable problems exist, there are no objections to a later sexual intercourse during the pregnancy. |
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Repetitive Total Cervix Occlusion?Question: Is it true if one had once an Total Cervix Occlusion, that the next pregnancy you need one again? Answer: Generally we would advise again to an Early Total Cervix Occlusion (ETCO). However, it is not like the Caesarean, which increases the risk for a Caesarean in the next pregnancy. Admittedly, cervix operations (possibly also an ETCO) rank among the list of risk factors for a preterm birth. However, crucial is probably that the increased risk of the preceding preterm birth often further exists. That is why after a successful pregnancy with ETCO in the next pregnancy ETCO appears advisable. In the meantime there are several women, who had two or even three pregnancies with ETCO without substantial problems. |
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Can a rupture of membranes or a bleeding be recognized after ETCO?Question: How can one determine a rupture of membranes or a bleeding if the cervix is closed? Answer: To the question concerning the rupture of membranes: If the cervix is actually completely closed, you do not have to fear a premature rupture of membranes, since this is in most cases caused by ascending vaginal infections. If only a Cerclage were accomplished, or the occlusion is not completely closed, then at least a certain protection from ascending infections exists (tightening of the cervix is favorably to the mucus clot in the cervix). In case of a Cerclage, we recommend additionally measuring your vaginal pH value regularly. A rise of the vaginal pH value can point not only to vaginal environment disturbances or infections (to be promptly treated), but also to a premature rupture of the membranes.
To the question concerning the bleedings: Slight bleedings are usually taken up by the body (absorbed). Stronger bleedings would lead to complaints (usually contractions and/or pain) and the haematoma can be recognized by a physician experienced in ultrasonography. We stress “experienced” since the haematoma is not always easy to differentiate from the surrounding tissue because of the echo density (see also Placenta praevia and ETCO). |
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Placenta praevia and ETCOQuestion: After two preterm births an ETCO should be accomplished at 14 weeks, but now the physicians have determined a placenta praevia and want to wait. Can an ETCO be accomplished – and what happens if bleedings should occur? Answer: Placenta praevia means that the placenta is placed at the lower pole of the uterus near the cervix, and covers the birth canal totally or partly. With a “total” placenta praevia, the birth canal is completely closed (i.e. a vaginal birth is not possible), with a placenta praevia marginalis (marginalis = at the edge) substantial bleedings can happen in the course of pregnancy or during birth. However, only after 24 completed gestational weeks it is actually spoken of “placenta praevia”, since because of the growth of the uterus it frequently happens, that the placenta departs laterally from the cervix. An Early Total Cervix Occlusion (ETCO) can also be accomplished with a placenta praevia, and one should not wait by any means, until it has moved. However, the occlusion should be accomplished in a hospital with special experience with the ETCO. Addresses for this can be obtained from us. In addition it is very important, that in your proximity there is a hospital with someone who has sufficient experience in ultrasonography for pregnant women (please clarify this before the intervention). Stronger bleedings caused by placenta praevia could lead to life-threatening blood loss. Since it cannot bleed outwards because of the occlusion, the bleeding cannot be recognized in the beginning. But stronger bleedings would lead to complaints (usually contractions) and the haematoma (the accumulation of blood between placenta and uterus wall) can be recognized by a physician experienced in ultrasonography. We stress “experienced” since the haematoma is not always easy to differentiate from the surrounding tissue because of the echo density. We also would like to refer to the following: If it comes to a bleeding with a placenta praevia, it happens whether an ETCO was accomplished or not (except during and shortly after the operation). With an ETCO the danger is that one cannot determine the bleeding easily as without occlusion there it would bleed visibly outwards. It is advisable that you always carry your expectant mother’s record. At best it also should be noted in an accompanying letter that a placenta praevia with a cervix occlusion is accomplished. Perhaps you also inform your family members and friends. With stronger complaints you should visit the hospital immediately and refer to this accompanying letter. Fortunately such threatening bleedings are not frequent. In comparison slight bleedings, as they seem with placenta praevia more frequently, are no larger problem: They are usually absorbed by the body like a “black and blue mark”. |
