Definition

What is cervical incompetence?

A cervical incompetence, or also known as a cervical insufficiency, is a disease that occurs when weak cervical tissue causes or contributes to premature birth or the loss of an otherwise healthy pregnancy.

Before pregnancy, your cervix, which is the lower part of the uterus that connects to the vagina, is normally closed and rigid. When pregnancy progresses and give birth is ready, the cervix gradually softens, decreases in length (effaces) and opens (dilates). If you have an incompetent cervix, your cervix might open sooner. It turns out that you are able to give birth too early than expected.

An incompetent cervix can be difficult to diagnose and, as a result, treat. If your cervix begins to open early, your health care provider might recommend preventive medication during pregnancy, frequent ultrasounds or a procedure that closes the cervix with strong sutures.

How common is cervical incompetence?

Cervical incompetence is relatively rare in the United States, occurring in only 1–2% of all pregnancies, but it is thought to cause as many as 20—25% of miscarriages in the second trimester.

Please discuss with your doctor for further information.

Symptoms

What are the symptoms of cervical incompetence?

Unfortunately, if you experience a cervical incompetence, you might not notice any signs or symptoms as your cervix begins to open during early pregnancy. Mild discomfort or spotting over the course of several days or weeks is feasible, however, starting between 14 and 20 weeks of pregnancy. Be on the lookout for:

  • A sensation of pelvic pressure
  • A backache
  • Mild abdominal cramps
  • A change in vaginal discharge
  • Light vaginal bleeding

When should I see my doctor?

If you have any signs or symptoms listed above or have any questions, please consulting with your doctor. Everyone’s body acts differently. It is always best to discuss with your doctor what is best for your situation.

Causes

What causes cervical incompetence?

Cervical insufficiency may occur as a result of a functional defect in the cervix, which can be due to an anatomic abnormality (congenital Müllerian anomalies), in utero exposure to diethylstilbestrol (DES), or collagen disorders (Ehlers-Danlos syndrome). Acquired causes of cervical insufficiency include obstetric trauma (e.g, cervical laceration during labor and delivery), mechanical dilation of the cervix during gynecologic procedures, and cervical conization, which may be performed via cold knife, laser, or loop electrosurgical excision procedure.

Risk factors

What increases my risk for cervical incompetence?

There are many risk factors for cervical incompetence such as:

Congenital conditions

Uterine abnormalities and genetic disorders affecting a fibrous type of protein that makes up your body’s connective tissues (collagen) might cause an incompetent cervix. Exposure to diethylstilbestrol (DES), a synthetic form of the hormone estrogen, before birth  has also been linked to cervical insufficiency.

Cervical trauma

If you experienced a cervical tear during a previous labor and delivery, you could have an incompetent cervix. Other surgical procedures involving the cervix, such as those to deal with an abnormal Pap test, may cause damage that contributes to cervical insufficiency.

Dilation and curettage (D&C).

This procedure is used to diagnose or treat various uterine conditions, such as heavy bleeding, or to clear the uterine lining after a miscarriage or abortion. On rare occasions it may cause structural damage to the cervix.

Diagnosis & treatment

The information provided is not a substitute for any medical advice. ALWAYS consult with your doctor for more information.

How is cervical incompetence diagnosed?

If your doctor suspects that you may experience this condition, a physical examination will be performed and some tests will be also recommended by your doctor. Your health care provider will check for evidence of any congenital conditions or cervical tears that might cause an incompetent cervix. Your health care provider will also check for contractions and, if necessary, monitor them.

These tests may include:

Transvaginal ultrasound

If the fetal membranes aren’t in your cervical canal or vagina, your health care provider will use transvaginal ultrasound to evaluate the length of your cervix, determine how much your cervix has dilated and examine the fetal membranes. During this type of ultrasound, a slender transducer is placed in your vagina to send out sound waves and gather the reflections of your cervix and lower uterus on a monitor.

Lab tests

If the fetal membranes are visible and an ultrasound shows signs of inflammation but you don’t have symptoms of an infection, your health care provider might test a sample of amniotic fluid (amniocentesis) to diagnose or rule out an infection of the amniotic sac and fluid (chorioamnionitis).

How is cervical incompetence treated?

Some treatment options of cervical incompetence may include:

Progesterone supplementation

If you have a history of premature birth, your health care provider might suggest weekly shots of a form of the hormone progesterone called hydroxyprogesterone caproate (Makena) during your second trimester. However, further research is needed to determine the best use of progesterone in cervical insufficiency. Currently, progesterone treatments don’t seem to be helpful for pregnancy with twins or more.

Serial ultrasounds

If you have a history of early premature birth, or you have had cervical damage in previous deliveries or operations, your health care provider might begin carefully monitoring the length of your cervix by giving you ultrasounds every two weeks from week 15 through week 24 of pregnancy. If your cervix begins to open or becomes shorter than a certain length, your health care provider might recommend cervical cerclage.

Cervical cerclage

If you are less than 24 weeks pregnant or have a history of early premature birth and an ultrasound shows that your cervix is opening, a surgical procedure known as cervical cerclage might help prevent premature birth. During this procedure, the cervix is stitched closed with strong sutures. The sutures will be removed during the last month of pregnancy or during labor.

Lifestyle changes & home remedies

What are some lifestyle changes or home remedies that can help me manage cervical incompetence?

The following lifestyles and home remedies might help you cope with cervical incompetence:

  • Restricting sexual activity or limiting certain physical activities
  • Bed rest might be recommended in some cases, although it isn’t a proven remedy for preventing premature birth

If you have any questions, please consult with your doctor to better understand the best solution for you

Hello Health Group does not provide medical advice, diagnosis or treatment.

Sources

Review Date: August 10, 2017 | Last Modified: August 10, 2017

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