#Surgical intervention can help avoid late-term miscarriage

Hopelessness could have stopped Lenora Wehye from giving up on her dream to have a child, but instead, she didn’t accept this as her fate.

Wehye, a now 40-year-old nurse from Jericho, LI, learned she was pregnant in June 2014. “I found out I was having a girl and went to the mall to buy shoes for her,” she said.

But, at 21 weeks, Wehye noticed a faint trace of pink in her urine.

“After a quick scan, the doctor came in and told me my cervix was opening and that I was funnelled, which means it was opening from the inside out,” she said. “I was advised I needed a vaginal cerclage [stitch], and although I felt scared, I had the surgery that week.”

One of the more common causes of recurrent second trimester loss is cervical insufficiency, where the cervix has a structural issue and opens early, said Michael L. Nimaroff, MD, senior vice president and executive director of obstetrics and gynecology for Northwell Health and chairman of the department of obstetrics and gynecology at North Shore University Hospital and Long Island Jewish Medical Center.

Fortunately, with treatment, most patients with this issue can have a successful outcome. Treatment includes administration of progesterone, and placement of a vaginal cerclage — a suture placed in the cervix by 12 weeks of pregnancy — which is over 65 percent successful.

Unfortunately, for Wehye, the fix came too late, and didn’t last.

“I hardly had any cervix at that point, from what I gather,” she said. “By week’s end, my water broke and the doctors said they needed to deliver the baby, who was 22 weeks.”

Although initially against it, “they told me I’d die of sepsis, and the baby wouldn’t make it either. It was the worst day, the hardest thing, but her lungs were not strong enough,” said Wehye, who was ultimately induced into labor.

“I delivered my daughter, Chloe. She was such a strong little girl. She came out alive and breathing. I was able to talk to her and kiss her,” said Wehye. “My family was able to give her love for an hour and a half, and then she died.”

Wehye’s relationship with Chloe’s father also ended, and though distraught for “a very long time — years,” Wehye later discussed having a child with her fiancé, Marc Nightingale, 49. But after her tragic loss, Wehye was scared to get pregnant.

“But I’d had no prior history [of a problem]. My earlier doctors didn’t check further. If they had caught this early enough, they could have tried a cerclage earlier on in my pregnancy. I didn’t know this. I was told what happened to me was a fluke,” she said.

Disturbed and dissatisfied, Wehye researched her condition.

“I wanted to know what my cervix was like. Apparently, it’s in the normal range when not pregnant, but once I’m in the second trimester, and the baby gets some weight on, my cervix can’t handle it,” she said.

Wehye learned of a process called transabdominal cerclage (TAC), and found Dr. Nimaroff in New York, one of only a handful of doctors in the area who perform the surgery. “In patients who have an extremely short cervix or who have failed a prior vaginal cerclage, placement of the cerclage abdominally can offer hope,” said Dr. Nimaroff.

“Often, this surgery can be accomplished through a minimally invasive approach,” he said. “It has an over 80 percent success rate. I’ve been doing these procedures for 10 years — they’re complicated surgeries but are very effective for those with truly challenging histories, who are so anxious to have a family and who have given up hope. It can be a life-changing procedure.”

In March 2019, Wehye met with Dr. Nimaroff.

“He said, ‘We’re going to fix this. We’re going to put this to bed.’ I welled up with tears. I’d needed to hear that from a doctor who would go to war with me,” said Wehye.

In May 2019, Wehye underwent a successful TAC surgery. She was pregnant just a couple of weeks later.

The TAC did what it was supposed to do and at 37 weeks and a day, baby Violet Amaya was born via cesarean section in February.

“I bawled my eyes out. Without [Dr. Nimaroff] and the work he does, this wouldn’t have happened,” said Wehye.

The other good news is that the stitch can be left in place for future pregnancies. “I’ve had patients who have had multiple pregnancies with the same cerclage,” said Dr. Nimaroff.

For those in similar situations, “You have to be your own advocate,” said Wehye. “Trust your gut. I had a lot of guilt after my first loss. I thought, ‘Why didn’t I ask questions?’ You need a doctor who will be on your team and explain things to you in a way that you understand,” said Wehye. “If it wasn’t for him and the care I received, I wouldn’t have my daughter.”

WHY THINGS GO WRONG

A single miscarriage is extremely common. It’s estimated that up to two-thirds of women will experience a loss in the first trimester.

“In some cases, [you] might not even be aware of the loss if it presents as a late or missed period,” said Dr. Daniel E. Stein, director of reproductive endocrinology and infertility at Mount Sinai West hospital and partner at Reproductive Medicine Associates of New York.

Recurrent losses (two or more) are far less common, probably occurring in less than 5 percent of pregnancies.

“At least half of miscarriages are due to chromosome abnormalities, but may also include other factors, including anatomical defects in the uterus, autoimmune factors for the mom, hormonal abnormalities, blood-clotting disorders and environmental factors,” said Dr. Stein. In the other half, no cause is ever found. “The next pregnancy might be completely normal, without any type of intervention,” he said.

The first course of action is a detailed look at a patient’s medical history, followed by a physical exam, pelvic ultrasound, and lab tests.

“Uterine, autoimmune, hormonal and clotting abnormalities can all be treated. In chromosomal cases, we can often achieve excellent success through in vitro fertilization (IVF),” said Dr. Stein.

If you’ve experienced two or more losses, “See an experienced board-certified reproductive endocrinologist,” said Dr. Stein. “There may very well be interventions that are highly successful. Don’t assume your issue is not treatable.”