When a female has weak cervical tissue that causes or contributes to premature birth or loss of a healthy pregnancy is called an incompetent cervix. Sometimes, it is called cervical insufficiency. The lower part of the uterus that opens to the vagina is called the cervix. Usually, before pregnancy, it is firm and closed and it begins to soften and open when the pregnancy is going to end. In other words, it gradually changes to prepare for delivery. Women with incompetent cervix can notice that it opens too early, which can cause premature birth.
This health condition can be challenging to diagnose and treat. So, if the cervix starts to open too early or you have experienced this problem in the past, you may benefit from treatment which includes cervical cerclage (a procedure that involves certain sutures that keep the cervix closed and help to prevent premature birth) and medicines. You may also need regular appointments with your doctor to check how things are going.
Symptoms
While some women do not experience any symptoms, others may have spotting or mild discomfort before diagnosis. The symptoms in people with incompetent cervix occur usually before 24 weeks of pregnancy. Check below some symptoms:
- Backaches
- Vaginal discharge changes
- Light vaginal bleeding
- Mild stomach cramps
- Feelings of pelvic pressure
If you experience any of the previous symptoms, do not hesitate to consult with your doctor.
Risk Factors
There are some risk factors that could increase the risk of an incompetent cervix. However, not every time doctors may identify risk factors for this condition. Check below some of them:
- Cervical trauma – These include surgery and other procedures (such as dilation and curettage (D&C). In rare cases, this condition may happen due to a tear during a previous pregnancy.
- Congenital conditions – Some genetic uterine conditions that increase the risk of an incompetent cervix.
Complications
People with incompetent cervix may experience the following complications without treatment. These include premature birth, pregnancy loss, and others. Discuss with your healthcare professional about ways to prevent complications.
Prevention
Although it is not possible to prevent an incompetent cervix, you can do different things that will help you to have a healthy and full-term pregnancy. Examples include:
- Regular checkups – It is advised to have regular appointments with your doctor to monitor your and your baby’s health. You should also inform your doctor about all problems and symptoms you experience during this period.
- Healthy diet – Pregnant women usually require an increased amount of folic acid, calcium, iron, and other nutrients. That’s why it is recommended to adopt a healthy diet full of these nutrients.
- Gain weight properly – For healthy people, the target of weight gain includes 25-35 pounds (11-16 kilograms). If you are gaining the correct amount of weight it may help to support the baby’s health.
- Do not take risky substances – These include tobacco products, alcoholic beverages, recreational drugs, any over-the-counter (OTC) medicines, and supplements. You can administer OTC drugs and supplements with your doctor’s approval only.
In addition, once a female experiences an incompetent cervix during the first pregnancy, the risk of getting complications such as premature birth or pregnancy loss elevates significantly. Discuss with your healthcare professional about ways to promote a healthy pregnancy if you decide to become pregnant again.
Diagnosis
Commonly, an incompetent cervix can be identified during pregnancy only. It may be challenging to diagnose this condition even during pregnancy, especially if it is the first one. Before diagnosis, doctors usually ask questions about symptoms and medical history. However, you should inform your healthcare professional if you have had a pregnancy loss in the second trimester and if you have a history of preterm delivery. Let your doctor know if you experienced any procedures or surgery on your cervix.
In most cases, physicians diagnose this condition if you have a history of widening of the cervix that is not painful (dilation) in the second-trimester delivery during the previous pregnancy, and if you have advanced cervical dilation and effacement. The process in which the cervix becomes softer and thinner is called effacement. Check below some tests done by doctors to diagnose incompetent cervix in the second trimester of pregnancy:
- Ultrasound – Doctors use during this test a thin wand-like device that helps to make images of the cervix and other tissues. This procedure is also known as transvaginal ultrasound and it helps doctors determine the length of the cervix and other abnormalities associated with the cervix.
- Pelvic examination – During this test, physicians commonly check for amniotic sac location. For instance, if the sac walls are in the cervical canal or vagina, it means that the cervix begins to open (prolapsed fetal membranes).
- Laboratory tests – Once your doctor identifies prolapsed fetal membranes, you may need to do some tests to exclude an infection. Sometimes, doctors may get a sample of the amniotic fluid and send it to the laboratory for testing (amniocentesis).
Unfortunately, there are no tests that can identify incompetent cervix before pregnancy or to predict if it will happen. However, tests such as ultrasound or MRI (magnetic resonance imaging) can find a congenital disease that may provoke an incompetent cervix.
Treatment
The treatment goal is to reduce symptoms and support a healthy pregnancy. The following treatment options can also prevent complications that may occur in people with an incompetent cervix. Examples include:
- Progesterone supplementation – Doctors usually recommend this medication that comes in gel or vaginal suppositories when a woman has a short cervix without preterm birth history. It helps to reduce the risk of preterm labor.
- Regular ultrasounds – You should have regular ultrasound tests if you have a history of premature birth or conditions that could increase the risk of an incompetent cervix. However, if your cervix starts to open or becomes shorter you may need a cervical cerclage.
- Cervical cerclage – This is an effective option to keep the cervix closed during pregnancy. Doctors often recommend this treatment option when an ultrasound test shows that the cervix begins to open or you have a history of premature births. In some cases, doctors may perform this procedure as a preventive measure before the cervix begins to open (prophylactic cervical cerclage).However, this is not an effective procedure for everyone who is at risk of premature birth. Discuss with your healthcare professional about the risks and benefits before this procedure.
- Pessary – This is a special device used to hold the uterus in place and reduce pressure on the cervix. In any case, experts continue studying if this device is effective in the treatment of an incompetent cervix.
Frequently Asked Questions
What are the first symptoms of an incompetent cervix?
If you experience this health problem, you usually will notice the following symptoms. For example:
- Abdominal or back pain
- Vaginal discharge
- Spotting or bleeding
- Vaginal pressure
In any case, it is advised to see a doctor who will help to exclude other health problems that provoke similar symptoms.
Are there ways to prevent an incompetent cervix?
Although you cannot prevent this condition the following tips can ensure a healthy and full-term pregnancy. Examples include:
- Gain weight properly during pregnancy
- Adopt a well-balanced diet full of nutrients required during pregnancy
- Administer prenatal vitamins
- Do not consume alcohol or recreational drugs
- Have regular appointments with your physician
- Avoid any nonprescription drugs or supplements without your healthcare professional approval
For more details, discuss it with your doctor.
What is the best treatment for people with an incompetent cervix?
The most effective treatment option for an incompetent cervix is cervical cerclage. The cervix is stitched tightly closed during this procedure. Thus, these stitches are removed usually in the last pregnancy month or right before delivery. Ask your healthcare professional if you have additional questions.
