Description

An incompetent cervix, occurs when weak cervical tissue causes or plays a part in premature birth or the loss of a healthy pregnancy. An incompetent cervix, also called a cervical insufficiency.

The cervix is the lower part of the uterus that opens into the vagina. Before pregnancy, normally closed and firm. As the pregnancy goes and prepares for childbirth, the cervix changes slowly. Softens, becomes more short-and opens up. If you have an incompetent cervix, you might begin to open too soon causing them to give birth before time.

An incompetent cervix can be a difficult problem to diagnose and treat. If the cervix begins to open prematurely, or if you have had a cervical insufficiency in the past, you may benefit from treatment. This may include having a procedure that is performed to close the cervix with a strong sutures, called cervical cerclage. You may also take medicines to help the incompetent cervix and have ultrasound exams to check how things are going.

Symptoms

With an incompetent cervix, it may be that there are no signs or symptoms during early pregnancy. Some women have mild discomfort or spotting before diagnosis. Often, this occurs before 24 weeks of pregnancy.

Be on the lookout for:

  • A feeling of pressure in the pelvis.
  • A new back pain.
  • Mild stomach cramps.
  • A change in the vaginal discharge.
  • Slight vaginal bleeding.

Risk factors

Many women do not have a known risk factor. The risk factors for an incompetent cervix include:

  • Cervical Trauma. A previous procedure or surgery on the cervix that could give rise to an incompetent cervix. This includes surgery to treat a problem cervical found during a Pap test. A procedure called dilatation and curettage (D&C) may also be associated with an incompetent cervix. Rarely, a cervical laceration during a previous labor and delivery may be a risk factor for an incompetent cervix.
  • A condition that you are born with. This is called a congenital condition. Certain uterine conditions could cause an incompetent cervix. Genetic problems that affect a type of protein that causes your body to the connective tissue, called collagen, which can lead to an incompetent cervix.

Complications

An incompetent cervix can be a risk to your pregnancy. Possible complications include:

  • The preterm birth.
  • The loss of the pregnancy.

Prevention

You can't avoid an incompetent cervix. But there is a lot that you can do to have a healthy, full-term pregnancy. For example:

  • Seek regular prenatal care. Regular check-ups during pregnancy can help your care team to monitor your health and the health of your baby. Tell your doctor about any signs or problems that are cause for concern, even if they seem silly or not important.
  • Eat a healthy diet. During pregnancy, you need more folic acid, calcium, iron and other essential nutrients. Take a daily prenatal vitamin can help if you are not eating enough healthy foods. Prenatal vitamins can be begun a few months before conception and continued throughout pregnancy.
  • The gain of weight the smart way. Get the right amount of weight can support health of your baby. A weight gain of 25 to 35 pounds, or about 11 to 16 kg, it is often the destination if you are at a healthy weight before pregnancy.
  • Avoid substances hazardous. If you smoke, stop smoking. Alcohol and illegal drugs are off limits too. Get permission from your doctor before taking any medication or supplement, including those that are available without a prescription.

If you've had an incompetent cervix during pregnancy, you are at risk of premature birth or the loss of a pregnancy in subsequent pregnancies. If you're considering to become pregnant, talk with your doctor to understand the risks and what you can do to promote a healthy pregnancy.

Diagnosis

An incompetent cervix can be found only during the pregnancy. It can be difficult to diagnose, especially during the first pregnancy.

Your doctor or another member of your care team may ask you about your symptoms and medical history. Be sure to tell your healthcare team if you have had a pregnancy loss in the second quarter from a past pregnancy or if you have a history of premature delivery. Also tell your health care team about any procedure that you have had in your cervix.

Your doctor can diagnose an incompetent cervix if you have:

  • A history of painless enlargement of the cervix, known as dilation, and second trimester of pregnancy, during the delivery of a past pregnancy.
  • Advanced cervical dilation and effacement before the 24th week of pregnancy. Effacement means that the cervix becomes thinner and softer. Cervical dilation and effacement can happen without painful contractions. Can also occur with vaginal bleeding, infection, or rupture of membranes, which is when the water breaks.

The diagnosis of an incompetent cervix during the second trimester may also include:

  • An ultrasound examination. During this test, you have a slender, wandlike device, called a transducer, is placed inside the vagina. This is known as a transvaginal ultrasound. The transducer emits sound waves that are converted into images that can be seen on a screen. This type of ultrasound can be used to verify the length of your cervix and see if the tissues are coming out of the cervix.
  • A pelvic examination. During a pelvic exam, the doctor will examine the cervix to see if the amniotic sac can be felt through the opening. The amniotic sac is where the baby is growing. If the wall of the sac in the cervical canal or vagina, it is called prolapse of the fetal membranes, and means that the cervix has started to open. Your doctor may also check to see if you have any of the contractions, and the follow-up of the same, if it is necessary.
  • The laboratory tests. If you have prolapse of the fetal membranes, you may need other tests to rule out an infection. In some cases, this can include taking a sample of amniotic fluid. This is called an amniocentesis. Amniocentesis can be used to verify the presence of infection in the amniotic sac and fluid.

There is No reliable evidence that can be done before pregnancy to predict if you're going to have an incompetent cervix. But certain tests before pregnancy, such as an ultrasound or mri , may help find congenital problems with the uterus that can cause an incompetent cervix.

Treatment

The treatment options or ways to manage an incompetent cervix include:

  • Progesterone supplementation. If you have a short cervix, without a history of preterm birth, vaginal progesterone can reduce your risk of having your baby too early. This medication comes in the form of a gel or a suppository that is inserted into the vagina each day.
  • Repeated ultrasound. If you have a history of early preterm birth, or a history that may increase your risk of an incompetent cervix, your doctor may closely monitor the length of your cervix. To do this, you have ultrasounds every two weeks from week 16 to week 24 of pregnancy. If the cervix begins to open, or becomes shorter than a certain length, you might need a cervical cerclage.
  • Cervical cerclage.During this procedure, the cervix is stitched closed tightly. The stitches will be removed during the last month of pregnancy or just before delivery. You may need a cervical cerclage if you are less than 24 weeks of pregnancy, you have a history of premature birth, and an ultrasound shows that the cervix is starting to open. Sometimes, cervical cerclage is performed as a preventive measure before the cervix begins to open. This is known as a prophylactic cervical cerclage. You can have this type of cervical cerclage if you've had an incompetent cervix with previous pregnancies. This procedure is often performed before 14 weeks of pregnancy. Cervical cerclage is not the best option for all people at risk of preterm delivery. For example, the procedure is not recommended if you are pregnant with twins or more. Be sure to talk with your doctor about the risks and benefits of cervical cerclage may be for you.
  • Pessary. A device called a pessary placed inside the vagina and keeps the uterus in place. A pessary can help to diminish the pressure on the cervix. But more research is needed to see if a pessary for the treatment of an incompetent cervix.

Cervical cerclage. During this procedure, the cervix is stitched closed tightly. The stitches will be removed during the last month of pregnancy or just before delivery. You may need a cervical cerclage if you are less than 24 weeks of pregnancy, you have a history of premature birth, and an ultrasound shows that the cervix is starting to open.

Sometimes, cervical cerclage is performed as a preventive measure before the cervix begins to open. This is known as a prophylactic cervical cerclage. You can have this type of cervical cerclage if you've had an incompetent cervix with previous pregnancies. This procedure is often performed before 14 weeks of pregnancy.

Cervical cerclage is not the best option for all people at risk of preterm delivery. For example, the procedure is not recommended if you are pregnant with twins or more. Be sure to talk with your doctor about the risks and benefits of cervical cerclage may be for you.

Lifestyle and home remedies

If you have an incompetent cervix, your doctor may suggest the limitation of sexual activity, or to avoid some other physical activities. This advice will depend on your individual situation.

Coping and support

It can be difficult to learn that it has an incompetent cervix. It can make you feel anxious about your pregnancy and the fear of thinking in the future. Ask your care team for suggestions about safe ways to relax.

Have a preterm birth can make you feel that you did something for the cause. Or that more could have been done to prevent this from happening. If you are struggling with these feelings, talk with your partner and loved ones, as well as your doctor. Try to focus your energy on caring for and getting to know your baby.

Preparing for your appointment

Tell your doctor about any risk factors you may have for an incompetent cervix. Also tell your doctor if you have any of the symptoms during the second trimester that you can have an incompetent cervix. Depending on the situation, you might need immediate medical attention.

Here's some information to help you prepare for your appointment, as well as what to expect from your health care provider.

What you can do

If there is time before your appointment, you may want to:

  • Find a loved one or friend who can join you to your appointment. Worry and anxiety can make it difficult to pay attention to what your doctor says. To have someone that can help you remember what you talked about during your appointment.
  • Write questions to ask their health care team. That way, you won't forget anything important to do. This can help you to make the most of your time with your doctor.

Basic questions to ask your doctor about the problems with the neck of the uterus during pregnancy include:

  • Has my cervix started to open it? If so, how much?
  • Is there anything I can do to help to continue with my pregnancy?
  • There are treatments that can make my pregnancy lasts more time or help the baby?
  • Do I have to be on bed rest? If so, for how long? What kind of things will you be able to do? I know that I have to be in the hospital?
  • What warning signs should make me a call?
  • What warning signs should make me to go to the hospital?
  • If my baby is born now, what can I expect?

Feel free to ask any other questions that occur to you.

What to expect from your doctor

Your doctor may ask you a series of questions, such as:

  • When did the symptoms begin?
  • Have you had any contractions?
  • Have you noticed changes in vaginal discharge?
  • Have you had any previous pregnancies, miscarriages or cervical surgeries that you have not mentioned?
  • How long will it take you to get to the hospital in case of an emergency, including the time to organize child care or a ride to the hospital?
  • Do you have friends or family nearby who could care for you if you need to rest in bed?
Symptoms and treatment of Incompetent cervix