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How soon after effacement and dilation does labor begin?
Q: How soon after starting to efface and dilate does labor begin? This is my third pregnancy, and I started dilating and effacing at 32 weeks. I was diagnosed with moderate high-grade dysplasia days before I found out I was pregnant. I’m curious if I will carry to term.
Melanie Cleveland, Ohio
A: Most women begin effacing and dilating in response to uterine contractions; many will enter labor if the contractions are allowed to continue. If a woman is diagnosed with premature contractions prior to 36 weeks gestation, she will likely be given instructions and treatments to try to prevent an early delivery. These may include bed rest, hydration (increased fluid intake), restricting activities and medication.

Other women dilate and efface because the cervix weakens. Premature dilation and effacement of the cervix without contractions is called cervical incompetence. Women who have been surgically treated for cervical dysplasia may have a shorter cervix and a higher risk of cervical incompetence. Other factors that put a woman at risk are a history of DES exposure, uterine anomalies, cervical trauma and a history of second trimester abortion. If cervical incompetence occurs early in gestation, it puts the pregnancy at higher risk of pregnancy loss or preterm delivery.

While early cervical change suggests a higher likelihood of delivering before your due date, this is not always the case. I have seen some women treated for preterm cervical dilation and effacement who have ultimately delivered at or beyond their due date.

In your situation, your health care provider should be monitoring your cervix frequently to determine whether you have cervical incompetence or preterm labor, and to decide whether any medical intervention is necessary to prevent an early delivery.

Laura E. Stachel M.D. Obstetrician & Gynecologist