Brittany Hewett knew her second pregnancy was high risk because she was expecting twins. What she didn’t plan on was facing premature delivery. When her obstetrician realized Baby A, baby boy Knox, was beginning to push through Brittany’s cervix just 25 weeks into the pregnancy, her obstetrician immediately sent Brittany to Angela Gray, MD, a maternal-fetal medicine specialist at Wilmington Maternal-Fetal Medicine. Dr. Gray is an expert in high-risk pregnancy and a procedure called cervical cerclage.
Because Brittany was carrying twins, she had seen Dr. Gray early in her pregnancy for evaluation. “I was there to support Brittany and her obstetrician should any complications arise,” said Dr. Gray. “At a routine appointment with her obstetrician, he realized Brittany was dilating early and Baby A’s foot was pushing through her cervix. He sent her to my office immediately for evaluation.”
A procedure to delay early labor
A cervical cerclage is a procedure performed on a woman whose cervix has weakened and/or begins to open early in a pregnancy. If the cervix becomes weakened or opens, it can increase the risk for miscarriage or early labor. To help extend the pregnancy, a cerclage involves a specialist placing a stitch or two to keep the cervix closed until the pregnancy is near full term. It is more complicated when the cervix is significantly dilated with exposed membranes.
When Brittany arrived at her appointment, she was 3 centimeters dilated with bulging membranes. “I felt she was a candidate for a rescue cerclage,” said Dr. Gray. “I explained the entire process, including the recovery and all of the risks. I also had a neonatologist from our NICU speak with Brittany to discuss the realities of premature birth, which could still occur even if I performed the cerclage.”
Brittany’s husband was unable to take time off of work for the evaluation with Dr. Gray, so Brittney’s mother was by her side during the appointment. Both Brittany and her mom are nurses. “We listened to the neonatologist explain the statistics for survival and complications if the twins were born prematurely,” said Hewett. “When the doctor left, I remember mama and I were just silent. When Dr. Gray came back into the room, it wasn’t a hard decision to move forward with the cerclage,” she said.
Preparing for a cervical cerclage
As part of the procedure, Dr. Gray admitted Brittany to the hospital and monitored her for contractions. Dr. Gray also prescribed steroids to help strengthen the babies’ lungs in case early delivery occurred. The NICU team was on standby. In the morning, Brittany received spinal anesthesia, then Dr. Gray gently pushed the membrane back into place and stitched the cervix in two places. The procedure itself took less than 30 minutes, though Brittany remained in the hospital for a week to be monitored for infection or other complications. She was then cleared to return to work without additional bed rest.
“The whole experience was a whirlwind of emotions, but I trusted Dr. Gray,” said Hewett.
On June 28, 2018, at 35 weeks, Brittney’s twins were born by cesarean section. Baby B, Kensley, was perfectly developed and headed home with no health complications. However, even at near full-term, Baby A, Knox, experienced some lung issues shortly after birth and was transferred back to Dr. Gray’s facility where he spent a short amount of time in intensive care.
Dr. Gray has performed countless cerclages during her 11 years of specializing in high-risk pregnancies. She emphasizes the importance of partnership among specialists as being essential to the success of the cerclage procedure, which relies on early identification. “It was a great pick-up by her referring physician,” said Dr. Gray. “I was happy to make every attempt to keep her babies out of the NICU.”
About Dr. Gray
Angela Gray, MD, is a maternal-fetal medicine specialist in North Carolina at Wilmington Maternal-Fetal Medicine, a MEDNAX affiliate, serving patients in the surrounding region. She is part of a team of specialists who work with referring physicians to help provide expert care for high-risk pregnancies.
Dr. Gray completed her medical degree at Ross University, School of Medicine, her OB/GYN residency at Bronx Lebanon Hospital Center and her MFM fellowship at the University of Rochester Medical Center. She is board certified in obstetrics & gynecology and maternal-fetal medicine.