An incompetent cervix (cervical insufficiency, cervical incompetence) is characterized by a weak cervix that results in premature birth or loss of pregnancy. A healthy cervix remains firm and closed until the body begins preparation for birth.
When the cervix is incompetent, connective tissues may be inherently weak or the cervix may dilate too soon. When cervical incompetence causes preterm birth, the baby is delivered between the 16th and 22nd week, thus resulting in prematurity or miscarriage. Risk increases for those with three or more 2nd trimester miscarriages, but the rate of occurrence for a second preterm birth is less than 30%. Risk factors are heightened in those with a short uterus, those with medical or accidental cervical injuries and in women with connective tissue disorders.
Some women experience no symptoms of an incompetent cervix. They only become aware of the problem after a preterm birth. Others have symptoms that last for days or weeks, thus allowing time for a treatment plan that could lower the risk of preterm birth. Those with symptoms may experience:
An incompetent cervix cannot be diagnosed before pregnancy, but abnormalities of the uterus can be discovered through a physical exam and/or imaging. Tests can be performed in the second trimester to evaluate and monitor the pregnancy. They may include:
An incompetent cervix is usually caused by weak muscles in the cervical and uterus regions. It can occur if a woman has suffered damage during a previous birth or has had an operation on the cervix. Expectant mothers who have suffered from an incompetent cervix before are likely to experience the same in the future.
A weakened cervix can also be caused by a malformation in the cervix. This is often as a result of a birth defect. Previous trauma to the cervix, such as dilation and curettage (D&C), can also cause this condition. Exposure to Diethylstilbestrol (DES), a synthetic hormone estrogen used to prevent miscarriage and pregnancy complications, can also cause cervical incompetence.
One or more previous miscarriages, especially in the second trimester, can also cause cervical insufficiency. Cervical cone biopsy due to an abnormal pap smear, if done incorrectly, may lead to cervical incompetence. Finally, some women are born with short cervices. These women are at a greater risk of developing recurrent second-trimester miscarriages, which causes cervical insufficiency. Finally, changes in hormonal levels during pregnancy have been linked to cervical incompetence.
The treatment for an incompetent cervix depend on the level of risk for preterm delivery.
Cervical incompetence is difficult to prevent. However, there is much you can do during pregnancy to ensure a healthy, full-term pregnancy. One of these is regular prenatal care. Through regular prenatal visits, your healthcare provider can monitor your health as well as your baby’s, looking out for signs of trouble during the pregnancy term.
Diet plays an important role in ensuring the success of a pregnancy. During pregnancy, ensure that you take enough calcium, folic acid, iron and other vital nutrients. A daily dosage of prenatal vitamins, preferably a few months after conception, can help meet dietary needs.
Avoid drinking, smoking or use of hard drugs. In addition, exercise extra caution when using certain medications, especially those administered over the counter. Always seek your healthcare provider’s approval before taking any supplements or medications. Finally, strenuous physical activity over the pregnancy period is not recommended.