Cervical Incompetence - Causes, Symptoms, Diagnosis, and Treatment

What Is Cervical Incompetence?

Before pregnancy, the cervix will be firm and closed, but as pregnancy progresses, the cervix softens, dilates, and decreases in length. Cervical incompetence is also called cervical insufficiency. It occurs when the cervix opens too early during pregnancy, leading to premature birth or the loss of healthy pregnancy.

Cervical incompetence can be difficult to diagnose and treat. In cases of cervical incompetence, or if a woman has a history of cervical incompetence, the doctor might recommend medication, frequent ultrasounds, or perform cervical cerclage (a procedure that closes the cervix with strong sutures) to prevent it during pregnancy.

What Are the Signs and Symptoms of Cervical Incompetence?

There may not be any evident signs of cervical incompetence during early pregnancy. But some women may experience mild spotting and discomfort throughout pregnancy or between 14 to 20 weeks.

The other signs of cervical incompetence are:

• Backache.

• Pelvic pressure.

• Mild abdominal cramps.

• Braxton-hicks like contractions.

• Vaginal discharge that changes from white or light yellow to tan or pink in color.

• Mild vaginal bleeding.

What Are the Causes of Cervical Incompetence?

There are a few conditions that increase the risk of a weak cervix, including:

• A procedure such as LEEP (loop electrosurgical excision procedure) or cone biopsy is done on the cervix.

• History of cervical incompetence in past pregnancies.

• History of uterine abnormalities.

• History of one or more second-trimester miscarriages.

• History of one or more spontaneous preterm deliveries.

• If the cervix was injured during a previous pregnancy or dilation and curettage.

• Ehlers-Danlos syndrome (a disorder that affects the connective tissues such as skin, blood vessels, and joints)

• Short cervix.

• Abnormally formed cervix or uterus.

How Is Cervical Incompetence Diagnosed?

Cervical incompetence is difficult to diagnose during pregnancy. No tests are available to diagnose before pregnancy. A few tests help in diagnosing cervical incompetence as follows:

• Pelvic Examination - The doctor will examine the cervix to see if there is a protrusion of the amniotic sac through the vaginal opening. If there is an indication of fetal membranes in the cervical canal, cervical incompetence is confirmed.

• Transvaginal Ultrasound - During this procedure, a slender transducer is placed inside the vagina to send sound waves that produce images on a monitor. This ultrasound helps evaluate the length of the cervix and check if membranes are protruding through the cervix.

• Lab Tests - If an ultrasound shows signs of inflammation and the fetal membranes are visible. Still, if there are no signs of an infection, the doctor might test a sample of amniotic fluid, called amniocentesis, to diagnose or rule out the infection of the amniotic fluid.

What Are the Treatment Options for Cervical Incompetence?

Treatments options for managing cervical incompetence might include:

Cervical Cerclage - During an ultrasound examination, if the cervix is shorter than 25 mm, the woman is less than 24 weeks pregnant, carrying a single baby, or has other risk factors for cervical incompetence, such as a prior preterm birth, the care providers may recommend a cerclage to reduce the risk of preterm delivery.

Cervical cerclage is a procedure typically done before week 14 of pregnancy, in which the cervix is stitched close with strong sutures. These stitches are usually removed during the last month of pregnancy or labor. It is usually performed using spinal anesthesia. Taking adequate rest is advised for a few days, during which light bleeding or cramping may be experienced. Sex is not advised for a while or possibly for the rest of the pregnancy.

Cervical cerclage is not appropriate for everyone at risk of premature birth. A cerclage may also be helpful if the cervix is opened one or more centimeters before 24 weeks when examined manually by a speculum. This procedure is also helpful for women who have had preterm births or multiple unexplained second-trimester losses and is not recommended for women carrying twins or more.

Progesterone Supplements - Women with a history of premature birth may be given extra weekly shots of a form of the hormone called Progesterone during their second and third trimesters to reduce the risk of recurrence. These weekly Progesterone shots will continue till 36 weeks. Progesterone can be inserted vaginally daily as an alternative option.

Steroids - If an ultrasound shows that the cervix is short and a woman is experiencing signs of premature labor, usually after 22 weeks, the health care practitioner may provide steroids. Combined with other medications, steroids can stop preterm labor and help the baby's lungs develop more quickly.

Bed Rest - If the doctor rules out cervical incompetence in the later stage of pregnancy, they may recommend bed rest for the rest of the pregnancy. This means staying in bed and not doing normal activities.

Repeated Ultrasound - If women have a history of early premature birth or a history of cervical incompetence, the doctor might begin carefully monitoring the length of the cervix by ultrasound examination every two weeks from 16 to 24 weeks of pregnancy. If the cervix becomes shorter than a certain length or begins to open, then the doctor might recommend cervical cerclage.

Is Cervical Incompetence Preventable?

Cervical incompetence cannot be prevented, but there are many things pregnant women should consider to promote a healthy, full-term pregnancy:

• Eat a Healthy Diet - During pregnancy, a woman requires more folic acid, iron, calcium, and other essential nutrients. A daily prenatal vitamin starting a few months before conception will help fill dietary gaps.

• Regular Prenatal Care - Regular prenatal visits can help the doctor monitor the mother's and baby's health. These visits help in clarifying any doubts a mother has.

• Adequate Weight Gain - The correct weight can support the baby's health. 25 to 35 pounds of weight gain is recommended for a healthy pregnancy.

• Avoid Smoking and Alcohol - If a woman smokes, drinks alcohol, or uses any illegal drug, it is recommended to quit before pregnancy. It is also recommended to take suggestions from doctors for supplements or other medicines.

Conclusion:

Cervical incompetence occurs when the cervix dilates or shortens too early during pregnancy which can cause premature birth and other complications. However, diagnosing cervical incompetence is very difficult during early pregnancy, but routine prenatal checkups and ultrasounds might help detect cervical incompetence.