During pregnancy as the baby grows and gets heavier, it exerts pressure on the cervix. This pressure may sometimes cause the cervix to start open before the baby is ready to be born. This condition is called incompetent cervix or weakened cervix. Cervical insufficiency occurs when weak cervical tissues cause or lead to premature birth or loss of an otherwise healthy pregnancy. Cervix is the lower part of the uterus that opens to the vagina. Before pregnancy, cervix is normally closed and firm. As your pregnancy progresses to advanced stages and you prepare to give birth, cervix softens gradually, decreases in length and dilates (opens). In the case of an incompetent cervix, the cervix might open too soon, leading to premature birth. An incompetent cervix may be a bit challenging to diagnose and treat. If the doctor suspects that your cervix will open early or you have a history of cervical insufficiency, your doctor might prescribe preventive medication during pregnancy, frequent scans like ultrasound or procedures that close the cervix with strong sutures (cervical cerclage).
What causes an incompetent or weakened cervix?
An incompetent or weakened cervix can occur due to one or more of the following conditions:
- Previous surgery on the cervix
- Damage during a difficult birth
- Malformed cervix or uterus from a birth defect
- Previous trauma to the cervix, such as a D&C (dilation and curettage) from a termination or a miscarriage
- DES (Diethylstilbestrol) exposure
Symptoms:
If you have incompetent cervix, you may not have any evident signs or symptoms during early stages of pregnancy. Some women may experience light discomfort or spotting over the course of pregnancy, starting between 14 to 20 weeks. The following are some of the symptoms that suggest the underlying issue of incompetent cervix:
- A sensation of pelvic pressure
- A new backache
- Mild abdominal cramps
- A change in vaginal discharge
- Light vaginal bleeding
Risk factors and complications:
Ironically, many women don’t have a known risk factor. However, congenital conditions like uterine abnormalities and genetic disorders damaging fibrous type of protein that makes up your body’s connective tissues called collagen might lead to an incompetent cervix.
Complications arising out of an incompetent cervix may include premature birth and pregnancy loss, particularly during the second trimester.
Diagnosis:
Diagnosis of an incompetent pregnancy can only be made during pregnancy. However, even during pregnancy, diagnosis can be challenging, particularly in first pregnancy as incompetent cervix is not routinely checked for during pregnancy. Your doctor may ask about any particular untoward symptom and your past medical history. Make sure you inform the doctor if you have had a pregnancy loss during the second trimester or if you had any procedure on your cervix. Normally, a diagnosis of incompetent cervix is made if you have a history of second trimester delivery coupled with painless cervical dilation. Vaginal bleeding, ruptured membrane (water breaking) and infection are other conditions that might lead your doctor to arrive at a diagnosis.
If your doctor is suspicious of you having an incompetent cervix, s/he may go in for some tests and procedures such as transvaginal ultrasound, pelvic exam and lab tests to confirm the diagnosis.
Treatment:
Treatment modalities to manage an incompetent cervix may include:
Progesterone supplementation: A weekly shot of hormone progesterone may be prescribed by your doctor if you have a history or premature birth. It starts during your second and third trimester.
Repeated ultrasounds: If you have a past medical history of premature delivery or you are suffering from conditions that increase your risk of premature cervical dilatation, your doctor will carefully monitor the length of your cervix by giving you ultrasounds every two weeks, right from 16 weeks through 24 weeks. If there are signs of your cervix opening or getting shorter than a certain length, your doctor might recommend cervical cerclage.
Cervical cerclage: It is a surgical procedure that might help prevent premature birth, if you are less than 24 weeks pregnant or have history of early premature birth. Strong sutures are used to stitch the cervix close together so that the sutures will reinforce the weak cervix. Sutures are not removed until the last month of pregnancy or the labor has set in. Removal of cerclage sutures will not result in spontaneous delivery of the baby. However, cervical cerclage is not a default procedure for everyone who is at risk of premature birth. The procedure is not recommended for women carrying twins or more, women with increased irritation of the cervix, women whose cervix has dilated more than 4 cm and the membranes have already ruptured.
Your doctor may also advise you to use a device called pessary. It fits inside the vagina and is designed to hold the uterus in place. A pessary reduces the pressure on the cervix to a large extent.
Preventing incompetent cervix:
You can’t prevent an incompetent cervix but there are things you can do to promote a healthy, full-term pregnancy. For example:
Regular consultation with doctor: Clinic visits can help your doctor monitor your health and your baby’s health. Mention any signs or symptoms that concern you.
Eat a healthy diet: Pregnancy period calls for more folic acid, calcium, iron and other essential nutrients, ideally starting a few months before conception.
Gain weight wisely: It is important to gain right amount of weight to support your baby’s health.
Avoid risky substances: Get your doctor’s consent before taking any medications or supplements, even those available over-the-counter.
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