What is incompetent cervix ?

 

 
Incompetent cervix is also known as weakened cervix or cervical insufficiency. It is a condition where cervical tissues become weakened and cause premature birth or loss of pregnancy. The cervix is normally closed and rigid. When one gets pregnant and as pregnancy progresses , the cervix gradually softens, effaces and dilates. With incompetent cervix, the cervix effaces (thins) or dilates before you get to full term of pregnancy causing you to give birth early. It may occur in the late second trimester or early third trimester. It is usually the cause of second trimester miscarriage,  preterm premature rupture of the membranes (PPROM) – (a condition that causes your membrane to rapture before you get to full term or before you go into labor) or preterm labor. This condition can be difficult to diagnose.

 

Who is at risk of incompetent cervix?

 
These factors may increase your risk of weakened cervix.

 
• previous surgery on the cervix
• uterine abnormalities or congenital disorders
• trauma to cervix such as such  a D&C (dilation and curettage)
• cervical tear during a difficult labor
• taking the drug DES (Diethylstilbestrol) while pregnant

 

What are the symptoms of incompetent cervix?

 
Signs and symptoms of incompetent cervix may not be immediately apparent. This is because your cervix starts to open in the late second trimester or early third trimester. You may however experience these signs when your cervix starts to open

 
• backache
• mild cramping
• pelvic pressure
• change in vaginal discharge
• spotting or light virginal bleeding

 

How do I know I have an incompetent cervix ?

 
There is no good way to detect incompetent cervix. It can only be diagnosed during pregnancy, even though it is usually difficult to diagnose in first pregnancy. Your health care provider will ask you for your medical history such as second trimester miscarriages and also document any symptoms you may be having. If your doctor suspects you have incompetent cervix, the following tests may be done  during the second trimester to confirm the condition.

 
Pelvic exam : Your doctor will do a pelvic exam to check if the amniotic sac has began to protrude through the opening of the cervix.

 
Transvaginal ultrasound : This is done to measure the length of the cervix and to check for effacement.

 
Lab test : Lab tests are done after signs of inflammation from an ultrasound. It is done to rule out any infection of an amniotic sac or fluid.

 

I am pregnant and have a weakened cervix…What’s next ?

 
Cervical cerclage : This is a surgical procedure that closes the cervix with strong sutures. It is usually done if you are less than 24 weeks or have a history of premature birth or an ultrasound shows that your cervix is opening. It is removed during the last month . Cervical cerclage is  usually performed in week 14-16 of pregnancy. This procedure cannot be done  if you have already dilated 4 cm, if your membrane has already raptured or cervix is increasingly irritated.

 
Your doctor may also suggest weekly shots in the form of the hormone progesterone called  hydroxyprogesterone caproate (Makena) during your second trimester if you have a history of premature birth.

 
You will also be monitored through a series of ultrasound every 2 weeks starting from week 15 of pregnancy.
 
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