What is cervical incompetence?
Cervical incompetence, also known as cervical insufficiency, occurs when cervical tissue is weak and cannot keep pregnancy to term. In other words, the cervix softens, effaces (shortens), and dilates (opens) early in pregnancy. This usually occurs in the second trimester or early in the third trimester, usually without pain or contractions.
Cervix is an outlet of the uterus (womb) that opens into the vagina. The baby passes through this outlet during birth. Some people may know it as the neck of the uterus.
A normal cervix softens, shortens, and dilates when pregnancy reaches full term, resulting in the birth of a baby. There may be associated contractions or pain.
In cervical incompetence, the cervical tissue is too weak to sustain the full term of the pregnancy, and it therefore softens, shortens, and dilates early in pregnancy (during second or early in third trimester) resulting in:
Miscarriage (loss of pregnancy before 20 weeks of pregnancy)
Premature birth (a baby born before 37 weeks of pregnancy)
What causes cervical incompetence?
The causes of cervical incompetence may be congenital or acquired.
Congenital causes such as connective tissue disorders (Ehlers-Danlos syndrome). Ehlers-Danlos syndrome is a condition caused by a deficiency of collagen (a protein required in the production of connective tissue). Another example of congenital causes is abnormalities of the uterus.
Acquired causes such as cervical trauma that occurred during childbirth, surgical procedures such as cervical cancer treatment (LLETS procedure, cone biopsy), dilatation and curettage procedure. In other cases, cervical incompetence is a result of infection or inflammation.
Who is at risk of cervical incompetence?
If you have had one or more of the below listed, you are at risk of cervical incompetence.
Previous pregnancy loss (especially in the second trimester or early in third trimester)
History of premature birth
Prior cerclage placement (surgical procedure for incompetent cervix)
Other surgical procedures: treatment for cervical cancer, where the pre-cancerous tissue is cut out (LLETZ procedure or Cone biopsy)
Congenital conditions: these are conditions that an individual is born with. Examples include abnormalities of the uterus and genetic disorders affecting connective tissue such as Ehlers-Danlos syndrome or Marfan syndrome.
The above listed risk factors do not represent all, but are some of the risk factors for cervical incompetence.
What are the signs and symptoms of cervical insufficiency?
Diagnosis of cervical incompetence can be made in three settings:
1. Some women may present with history of second or early third trimester pregnancy loss or history of one or more premature births.
2. Some present asymptomatically.
In this case a diagnosis may be made by physical examination and tests, or procedures done by a doctor (transvaginal ultrasound, vaginal swabs).
3. Others may present with the following clinical features:
(Signs and symptoms of premature labor)
Pelvic pressure
Cramps
Back pain
Increased vaginal discharge
Spotting or light bleeding
It is important to know the signs of premature labour, because it may result in delivery of a preterm baby (baby born before 34 weeks of pregnancy). Should you experience any of the above signs, do not hesitate to call your doctor, although it may be a false alarm, better safe than sorry.
How can I prevent cervical incompetence?
Cervical incompetence cannot be prevented but there are measures that can be employed to ensure a healthy pregnancy that can be sustained to full term.
Regular attendance of antenatal clinic: the doctor monitors your health and that of the baby. The doctor can assess and pick up warning signs and manage them sooner. You may also discuss any of your concerns during the visits.
Healthy diet: take all supplements as prescribed (folate, iron, calcium) and follow a healthy diet. A healthy diet is associated with heathy pregnancy outcomes.
Do not smoke, drink alcohol, or use any illicit drugs during pregnancy and seek a doctor’s advice before taking any medication.
Appropriate birth spacing reduces the risk of premature birth, it may benefit you to discuss this with your doctor.
Comply with treatment for chronic conditions especially Diabetes and blood pressure. If Diabetes and blood pressure are not well managed, they may result in preterm labor.
Sometimes, depending on the case, a doctor may recommend activity restriction: such as sexual activity. You may also be advised to be on bed rest for a specific period of time.
Can I still have children with cervical incompetence?
Absolutely! If your doctor diagnoses you with cervical incompetence or you have had previous miscarriage or premature birth, do not worry. Comply with the promotive healthy pregnancy measures discussed above and consult a doctor as early as possible. There are medical and surgical interventions instituted to support an incompetent cervix.
To state a few, medically your doctor may suggest weekly progesterone shots to stop contractions. As mentioned, regular prenatal visits to a doctor, allows a doctor to monitor the length of the cervix by repeated ultrasounds (2 weekly starting from the 16th week to 24th week of pregnancy). If the cervix shortens, the doctor may suggest cervical cerclage. Cervical cerclage is a surgical procedure that involves stitching the cervix closed to prevent premature birth.
Take Home Message
If you have been diagnosed with cervical incompetence, you are at risk of premature birth and pregnancy loss in future pregnancies, but remember that you can call your doctor and receive supportive management and deliver safely!
This article is written by Dr Katleho Tau (MBChB)
References:
1. Pruthi S, Acosta A. Incompetent cervix - Symptoms and causes [Internet]. Mayo Clinic. 2022. Available from: https://www.mayoclinic.org/diseases-conditions/incompetent-cervix/symptoms-causes/syc-203738361.
2. Tommy’s. A weak cervix (cervical incompetence or cervical insufficiency) [Internet]. Tommy’s pregnancy Hub.2022. https://www.tommys.org/pregnancy-information/pregnancy-complications/cervical-incompetence
3. Norwitz E R, Talavera F, Ramus R M. Cervical Insufficiency. [Internet]. Medscape. 2021. Available from: https://emedicine.medscape.com/article/1979914-overview
4. Pruthi S, Acosta A. Incompetent Cervix-Diagnosis and Treatment. [internet]. Mayo Clinic. 2021. Available from: https://www.myoclinic.org/diseases-condition-incompetent-cervix/symptoms-causes/syc-20373836
5. Thakur M, Mahajan K. Cervical Incompetence. [Internet]. Stat Pearls Publishing, Treasure Island (FL). 2021. Available from: https://www.ncbi.nlm.gov/books/NBK525954/
Comments