“Not once, but three times. All in a space of three years. I watched my hopes of becoming a mother slip away. I lost my pregnancies at 14 to 16 weeks twice and then the third time, devastatingly, at just three to four weeks.
“The pain of these losses was almost too much to bear,” ‘Makhahleho Matoetoe (25) recalls, her voice quivering with emotion.
For Matoetoe, the anguish of a miscarriage was an all-too-familiar torment that began in 2018 when she experienced her first pregnancy, only to lose it in the second trimester. From that point on, each year brought with it another pregnancy and, a cycle of losses that persisted until 2021.
That is where in the midst of her despair, Matoetoe was offered a glimmer of hope in the form of cervical cerclage, a surgical procedure that involves placing a stitch or band around a woman’s cervix to help keep it closed during pregnancy period.
The process is performed in the second trimester of pregnancy to help prevent premature birth or miscarriage.
After these losses, Matoetoe felt herself spiralling into despair. The physical and emotional toll of miscarriages left her feeling broken and adrift, isolated in her grief, as she feared her dream of becoming a mother would remain just that – a dream forever out of reach.
“With the second miscarriage, I thought I was losing my mind,” she recalls with her eyes glistening with tears.
“I felt so alone, so lost. It felt like a piece of my soul was being torn away. I started to believe that it was never going to happen for me, that I was destined to live with the grief for the rest of my life,” she says.
Matoetoe says at 12 weeks of pregnancy in 2021; she was desperate to receive the cervical cerclage procedure before it was too late. But the first hospital she visited had a long waiting list, and she feared that by the time she would be attended to, she would have already lost her pregnancy.
Unable to bear the thought of another miscarriage, she sought help at Machabeng Hospital in Qacha’s Nek district, which admitted her for a week before performing the cervical cerclage surgery. Miraculously, surgery proved successful.
Matoetoe says at 38 weeks pregnant, the stitches were removed, and she waited anxiously for her baby’s arrival. The baby was a week overdue but born with no complications.
She returned to her normal life, but in 2021, as she approached the stage where she had previously lost her pregnancies, she got worried as she again began to experience familiar symptoms such as cramps and vomiting.
“I was worried when I felt those familiar cramps. But this time there was no bleeding. I realised then that the cervical cerclage process has likely saved my pregnancy and with it, I successfully delivered a daughter who is now three years old,” Matoetoe noted.
Dr Mojalefa Bulane, who has extensive experience in the area of high-risk pregnancies, shared his insights and expertise on cervical cerclage.
He noted that cervical cerclage, known as purse string stitch, is performed for everyone who loses a baby at 10 to 24 weeks, or at the mid-trimester stage, due to an incompetent cervix.
In a striking statement that highlights the importance of proper diagnosis and treatment, Dr Bulane states: “If a woman experiences multiple miscarriages between 10 to 24 weeks of gestation, it is highly likely that she has an incompetent cervix. This condition, if left untreated, can lead to devastating losses for the woman and her family.
“As the foetus grows, the cervix may become week or incompetent, increasing the risk of preterm labour and premature birth, by performing a cerclage, we effectively stitch the cervix closed, to help support the growing foetus and reduce the risk of miscarriage.”
The placement of the stitches, he says, is typically a relatively straightforward surgical procedure. Depending on the circumstances and the preference of the treating doctor, the stitches can either be removed at 37 to 38 weeks of pregnancy to allow for natural labour, or they can be left in place and cut during labour.
Dr Bulane points out that for women who have undergone cervical cerclage in a previous pregnancy, it is often practical to repeat the procedure in subsequent pregnancies.
In many cases, a history of cervical incompetence is a strong predictor of future problems, especially when it occurs from 10 to 24 weeks, cerclage can therefore prevent these implications, Dr Bulane explains.
He further stresses the importance of cervical cerclage as a potentially life-saving procedure, noting that the procedure is not just a recommendation for women with a history of cervical insufficiency, but a necessary intervention to prevent further pregnancy loss.
Without the procedure, a woman who has experienced recurrent miscarriages due to an incompetent cervix will continue losing pregnancies.
“It is a simple, yet powerful, surgical solution that can make a profound difference in the lives of families affected by this tragic condition,” he notes.
He adds that in many occasions, the first miscarriage may not clearly indicate the need for cervical cerclage. However, by tracking the gestational stage and subsequent miscarriages, a pattern may emerge, that points to cervical incompetence as the cause.
Dr Bulane encouraged women to keep detailed record of their reproductive history, so that doctors can make an accurate diagnosis and provide appropriate treatment to prevent further heartbreak.
He notes that when performed under the right circumstances and with appropriate care, cervical cerclage is a safe and effective procedure. The decision to undergo cerclage should always be made in consultation with a qualified obstetrician or maternal-foetal medicine (MFM) specialist who can assess risks and benefits.
Lesotho’s infant mortality rate continues to pose a significant challenge to the country’s development, according to the latest data from the World Bank.
As of 2022, the infant mortality rate stood at 56.4 deaths per 1,000 live births, highlighting the ongoing struggle to improve healthcare service and reduce child mortality rates. Lesotho’s infant mortality rate remains among the highest in the world.
Studies show that in Africa, approximately two percent of pregnant women at risk of pre-term birth-up to 15,000 a year – have a cervical cerclage to try and prevent the premature labour. The procedure is commonly performed worldwide used in up to five percent of pregnancies. The study further shows that very preterm birth of less than 32 weeks’ gestation is the biggest cause of mortality, neurological complications, neuropsychiatric and behavioural disorders in later life.
