Incompetent Cervix- Signs, Diagnosis and Effects

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In this article:

What is an Incompetent Cervix?
What are the Signs of an Incompetent Cervix?
Are there any Tests?
How Common is an Incompetent Cervix?
How Will an Incompetent Cervix Affect My Baby?
What’s the Best Way to Treat an Incompetent Cervix?
What Can I Do to Prevent?
What do other Pregnant Moms do when they have an Incompetent Cervix?

What is an Incompetent Cervix?

An incompetent cervix occurs when weak cervical tissue causes or contributes to premature birth or the loss of an otherwise healthy pregnancy. It is also called as cervical insufficiency.

The cervix is lower part of the uterus that opens to the vagina. Before pregnancy it is normally closed and firm. As pregnancy progresses and the mother prepare to give birth, the cervix gradually softens, decreases in length (effaces) and opens (dilates). If there is an incompetent cervix, it might begin to open too soon causing to give birth too early.

incompetent cervix

All You Need to Know about Incompetent Cervix

What are the Signs of an Incompetent Cervix?

In an incompetent cervix there are no signs and symptoms during early pregnancy. Some women experience mild discomfort or spotting over the course of several days or weeks starting between 14 and 20 weeks of pregnancy. Some signs that can be seen are –

Are there any Tests?

During pregnancy only an incompetent cervix can be diagnosed. Also the diagnosis can be difficult particularly during a first pregnancy. The doctor will ask about any symptoms seen and medical history. Be sure to let the doctor know if there was a pregnancy loss during the second trimester or a procedure on the cervix.

Tests and procedures that help in diagnosis during the second trimester include –

  • Transvaginal ultrasound – the doctor may use transvaginal ultrasound to evaluate the length of the cervix and to check if membranes are protruding through the cervix. During this type of ultrasound, a slender transducer is placed in the vagina to send out sound waves that generate images on a monitor.
  • Pelvic exam – the doctor will examine the cervix to see if the amniotic sac has begun to protrude through the opening (prolapsed fetal membranes). If the fetal membranes are in the cervical canal or vagina, this indicates cervical insufficiency. The doctor will also check for contractions and necessary monitor them.
  • Lab tests – if fetal membranes are visible and an ultrasound shows signs of inflammation but don’t have an infection, the doctor may test a sample of amniotic fluid (amniocentesis) to diagnose an infection of the amniotic sac and fluid (chorioamnionitis).

These aren’t any tests that can be done before pregnancy to reliably predict an incompetent cervix. However, certain tests done before pregnancy like an MRI or an ultrasound, can help detect uterine abnormalities that might cause an incompetent cervix.

How Common is an Incompetent Cervix?

Many women don’t have a known risk factor. It is commonly seen in –

  • Cervical trauma – some surgical procedures used to treat cervical abnormalities associated with an abnormal Pap smear which can result in cervical insufficiency. Other surgical procedures include D&C could also be associated with this.
  • Race – balck women seen to have a higher risk but the reason is not known.
  • Congenital conditions – uterine abnormalities and genetic disorders affecting a fibrous type of protein that makes up the body’s connective tissues (collagen) might cause an incompetent cervix. Exposure to diethystilbestrol (DES), a synthetic form of the hormone estrogen, before birth also has been linked to cervical insufficiency.

It happens in about 1-2% of pregnancies. Almost 25% of babies miscarried in the second trimester are due to an incompetent cervix.

How Will an Incompetent Cervix Affect My Baby?

An incompetent cervix poses risks for the pregnancy particularly during the second trimester and the baby includes –

What’s the Best Way to Treat an Incompetent Cervix?

Treatment include –

  • Progesterone supplementation – if there is a history of premature birth, the doctor might suggest weekly shots of a form of the hormone progesterone called hydroxyprogesterone caproate (Makena) during the second and third trimester.
  • Repeated ultrasounds – if there is a history of early premature birth or a history that may increase the risk of cervical insufficiency, the doctor might begin carefully monitoring the length of the cervix by giving ultrasounds every two weeks from week 16 through week 24 of pregnancy. If the cervix begins to open or becomes shorter than a certain length, the doctor might recommend cervical cerclage.
  • Cervical cerclage – if less than 24 weeks pregnant or have a history of early premature birth and an ultrasound shows that the cervix is opening, a surgical procedure known as cervical cerclage is done which 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.

What Can I Do to Prevent?

An incompetent cervix can’t be prevented. But there’s much can be done to promote a healthy, full-term pregnancy which include –

  • Seek regular prenatal care – prenatal visits can help the doctor monitor the health of mother and baby. Mention any signs and symptoms that are found, even if they seem silly or unimportant.
  • Eat a healthy diet – during pregnancy, need of folic acid, calcium, iron and other essential nutrients is increased. A daily prenatal vitamin ideally starting a few months before conception will help to fill any dietary gaps. Avoid smoking, alcohol and illegal drugs.
  • Gain weight wisely – gaining the right amount of weight is good for healthy baby. A weight gain of 25to 35 pounds (about 11 to 16 kilograms) is often recommended for a woman for a healthy weight before pregnancy.

What do other Pregnant Moms do when they have an Incompetent Cervix?

If the woman is pregnant and have risk factors for an incompetent cervix or experience any symptoms during the second trimester that indicate an incompetent cervix, consult the doctor right away. Depending on the circumstances, might need immediate medical care.

Conclusion

An incompetent cervix during one pregnancy, there is risk of premature birth or pregnancy loss in later pregnancies. It is difficult to diagnose and treat. Consult the doctor for proper management.

References

https://www.mayoclinic.org/diseases-conditions/incompetent-cervix/symptoms-causes/syc-20373836

https://www.mayoclinic.org/diseases-conditions/incompetent-cervix/diagnosis-treatment/drc-20373842

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