Incompetent Cervix: Symptoms, Causes, Treatment

What are the symptoms of an incompetent cervix?

An incompetent cervix, also known as cervical insufficiency, is a condition where the cervix begins to dilate and efface (thin out) prematurely during pregnancy, typically in the second trimester. This can lead to the following symptoms:

1. Painless Cervical Dilation: One of the hallmark signs is painless opening or dilation of the cervix without contractions, usually detected during a routine prenatal exam or ultrasound.
2. Increased Vaginal Discharge: Some women may notice an increase in vaginal discharge, which can be clear, pink, or tinged with blood.
3. Pelvic Pressure: A sensation of pressure or heaviness in the pelvic area may occur as the cervix begins to dilate.
4. Backache: Some women may experience mild back discomfort or a dull ache in the lower back.
5. Change in Vaginal Sensation: Women may feel a change in vaginal sensation or notice a feeling of fullness or pressure in the vagina.

These symptoms can vary in severity and may not always be present. If a woman has had a previous history of preterm birth or cervical procedures (like cone biopsy or LEEP), she may be at higher risk for incompetent cervix and should be monitored closely during pregnancy. Prompt diagnosis and management are crucial to prevent preterm labor and delivery, which can lead to complications for the baby.

What are the causes of an incompetent cervix?

The exact cause of an incompetent cervix, also known as cervical insufficiency, is not always clear. However, several factors and conditions may contribute to its development:

1. Previous Cervical Trauma: Previous cervical procedures such as cone biopsy, loop electrosurgical excision procedure (LEEP), or dilation and curettage (D&C) can weaken the cervix and increase the risk of cervical insufficiency.
2. Congenital Defects: Some women may have a congenital (present at birth) weakness in the cervix that predisposes them to cervical insufficiency.
3. Uterine Anomalies: Certain structural abnormalities of the uterus, such as a septate uterus (where the uterus is divided by a septum), can also contribute to cervical insufficiency.
4. Hormonal Factors: Hormonal changes during pregnancy, particularly changes in progesterone levels, may affect cervical integrity and contribute to cervical insufficiency.
5. Inflammation or Infection: Infections of the cervix or uterus, such as pelvic inflammatory disease (PID), may lead to inflammation and weaken cervical tissues.
6. Multiple Pregnancies: Carrying twins or higher-order multiples increases the risk of cervical insufficiency due to the increased pressure on the cervix and uterus.
7. DES Exposure: Women whose mothers took diethylstilbestrol (DES) during pregnancy have an increased risk of cervical abnormalities, including cervical insufficiency.
8. Idiopathic: In some cases, cervical insufficiency may occur without an identifiable cause, which is referred to as idiopathic cervical insufficiency.

It’s important to note that not all women with risk factors will develop cervical insufficiency, and the condition can sometimes occur unexpectedly in women with no known risk factors. Diagnosis is typically made based on symptoms, history, and findings during prenatal care, and management involves measures to support the cervix during pregnancy to reduce the risk of preterm birth.

How is the diagnosis of incompetent cervix made?

Diagnosing incompetent cervix typically involves a combination of medical history, physical examination, and sometimes imaging studies. Here’s how the diagnosis is typically made:

1. Medical History: The doctor will review your medical history, including any previous pregnancies, miscarriages, preterm births, or cervical procedures (such as cone biopsy or LEEP).
2. Physical Examination: During a pelvic exam, the doctor will assess the cervix for signs of dilation, effacement (thinning), or other abnormalities. They may use a speculum to visualize the cervix and perform a digital exam to check for cervical changes.
3. Ultrasound: Transvaginal ultrasound is often used to measure the length of the cervix. A short cervix (<25 mm before 24 weeks of pregnancy) may indicate cervical insufficiency. Serial ultrasounds may be done to monitor changes in cervical length over time.
4. Cervical Biopsy (rarely): In some cases, a cervical biopsy may be performed to evaluate the tissue for abnormalities if cervical insufficiency is suspected but not confirmed by other means.
5. Previous History: If a woman has a history of painless second-trimester losses or preterm births without obvious cause, this may suggest a pattern consistent with cervical insufficiency.

Diagnosing incompetent cervix can be challenging because symptoms may not always be present until later in pregnancy. In some cases, cervical insufficiency is diagnosed after a woman has already experienced a late miscarriage or preterm birth. Early diagnosis is beneficial as it allows for proactive management to help support the cervix and potentially reduce the risk of preterm birth in subsequent pregnancies.

Women with risk factors for incompetent cervix, such as previous cervical procedures or a history of second-trimester losses, may be monitored more closely during pregnancy with regular cervical length assessments via ultrasound starting early in the second trimester. If diagnosed, treatment options such as cervical cerclage (a surgical procedure to stitch the cervix closed) or progesterone supplementation may be recommended to help support the cervix and reduce the risk of premature delivery.

What is the treatment for an incompetent cervix?

The treatment for an incompetent cervix, also known as cervical insufficiency, aims to support the cervix during pregnancy to reduce the risk of premature birth. Treatment options include:

1. Cervical Cerclage: This is a surgical procedure where a stitch (suture) is placed around the cervix to help hold it closed and provide support. Cerclage is typically performed between 12 and 14 weeks of pregnancy in women with a history of cervical insufficiency or short cervix identified on ultrasound. There are different types of cerclage:

• Transvaginal Cerclage: This is the most common type, where the stitch is placed around the cervix through the vagina.
• Transabdominal Cerclage: This is less common and involves placing the stitch around the cervix through the abdomen.

1. Progesterone Supplementation: Progesterone, a hormone that helps maintain pregnancy, may be prescribed to help support cervical integrity. This can be in the form of injections, vaginal suppositories, or oral tablets.
2. Monitoring: Women with cervical insufficiency are often monitored closely throughout pregnancy with regular cervical length assessments via ultrasound to detect any changes that may indicate the cervix is opening prematurely.
3. Bed Rest: In some cases, bed rest or reduced activity may be recommended to minimize pressure on the cervix and reduce the risk of premature dilation.
4. Avoiding Certain Activities: Women with cervical insufficiency may be advised to avoid activities that could potentially increase pressure on the cervix, such as heavy lifting or sexual intercourse.
5. Medications: In some cases, medications such as antibiotics or tocolytic drugs (which can temporarily inhibit uterine contractions) may be used if there is concern about infection or premature labor.
6. Management of Complications: If preterm labor does occur despite treatment, healthcare providers will manage it with medications to slow or stop labor and provide supportive care for the baby.

The choice of treatment depends on factors such as the woman’s medical history, the length of the cervix, and any previous outcomes in pregnancies. It’s important for women with cervical insufficiency to receive care from a healthcare provider experienced in managing high-risk pregnancies to optimize outcomes for both mother and baby. Early detection and intervention can significantly improve the chances of carrying the pregnancy to term.