### instruction:
If you are a doctor, please answer the medical questions based on the patient's description.

### input:
Hi Dr Chetna, how are you? I hope you re doing fine & I d like to say in advance how much I appreciate your feedback regarding this urgent situation. My sister who currently resides in Jakarta, Indonesia is 3 months pregnant and is not doing well now. She had severe bleeding a few weeks ago, but was told that her baby survived the crisis & is still ok. She has been advised by a doctor there to go for surgery to sew up her womb, but a 2nd opinion from another doctor advised her against it. She also suffers from pain as well now & is unsure what to do. She s been told that her womb is weak, that is why she had the bleeding & may face complications later on in her pregnancy. Please help give us advice on what possible options are available to her, & whether surgery may be the best option, & what the risks are. She is very worried & scared & we are all uncertain what to do, but I d like to help her. Sincerely appreciate your kind assistance in this matter. Regards, Natasha.

### output:

Dear Natasha, It seems your doctor has suspected weakness in the mouth of the uterus. It is called as incompetent cervix. This deficiency leads to repeated abortions in the middle three months of pregnancy. If the diagnosis is right, you will require a stitch around the mouth of the uterus (cervix) to reinforce it. However, such condition threatens the pregnancy between 14 weeks to 28 weeks of pregnancy. Moreover, severe bleeding does not fit into the clinical picture of incompetent cervical OS.  Therefore, you have first to find out the cause of the bleeding. Placental separation from a normally situated placenta (abrupt placenta) or from low-lying placenta (placenta Pravda) - both are rather threatening conditions. The formal leads to bleeding with pain while the latter is a painless, causeless and recurrent bleeding. However, these accidents take place in the later half of the pregnancy. If the cause for the bleeding is completely cured, there is no possibility for recurrent bleeding, and you have incompetent cervical OS, you will have to undergo encircle of the cervix. Ultrasonography at this stage will help you to reach the diagnosis. It will locate the site of bleeding and whether it has completely stopped, it will locate the site of placenta, and also it will find out the status of cervical OS. However, tightening the cervix before 14 weeks of pregnancy are completed cannot be accepted scientifically. Madam, from your history, I do not feel you are having incompetent cervical OS. Please get the cause of your bleeding diagnosed from a Gynecologist first by required investigations and concentrate on the treatment for that. I hope this will guide you appropriately.  