Cervical insufficiency is a difficult condition to diagnose, especially for new mothers. It is best to have regular prenatal checkups and report any symptoms to your doctor.
Cervical insufficiency is also familiar to people as incompetent cervix. It occurs when the cervix dilates too early during pregnancy, usually without any other symptoms. This leads to premature labor or miscarriage.
Typically, this area dilates only when labor begins, in response to contractions. If there is insufficiency of the cervix, this dilation occurs during the second trimester of pregnancy, without pain or contractions.
This abnormality can only be detected when a woman is pregnant. In other conditions, her uterus looks normal. If a woman has had cervical insufficiency in a previous pregnancy, the same will most likely happen in other pregnancies.
Common symptoms of cervical insufficiency
Cervical insufficiency is an abnormality that causes dilation during early stages of pregnancy.
Cervical insufficiency does not cause any symptoms in early pregnancy. Only some women experience light bleeding during weeks 14-20 of gestation. Such bleeding can last a few days or several weeks.
Also, some women experience discomfort during the second trimester of pregnancy, such as the following:
- Changes in vaginal discharge.
- Sensation of pressure in the pelvis.
- A pain in the back that is experienced as strange.
- Mild abdominal cramps.
What causes it?
Science has not been able to establish what the specific cause of cervical insufficiency is. However, some of the factors that increase the risk of suffering from this anomaly have been pointed out. The most important are the following:
- Multiple pregnancy. Cervical insufficiency occurs more often in women who have multiple babies simultaneously.
- Having had a cervical tear in a previous delivery.
- LEEP Background. This is an excisional electrosurgical procedure done to prevent uterine cancer.
- Congenital connective tissue disorder. It includes several abnormalities in the uterus that occur at birth, such as Ehlers-Danlos syndrome.
- Congenital defects of the uterus. They are present at birth and mean that the uterus has an abnormality.
- Injury or trauma to the cervix.
- Exposure to diethylstilbestrol. This is a hormonal drug. If a woman’s mother has taken this medicine when she was carrying her, she increases the risk of cervical insufficiency.
- Women who have had miscarriages, particularly if they occur before the fourth month, are at increased risk for cervical failure.
Diagnosis of cervical insufficiency
The diagnosis of cervical insufficiency is difficult, especially when it comes to the first pregnancy. If the healthcare provider suspects this abnormality, they may order some tests and procedures to confirm it.
The usual diagnostic tests are as follows:
- Transvaginal ultrasound. This test allows you to measure the length of the cervix and establish whether there are membranes protruding through it. If the neck is less than 25 millimeters, then the doctor can confim the cervical insufficiency.
- Pelvic exam It is a visual and manual inspection that allows to establish if the amniotic sac and the fetal membranes are in place or not.
- Laboratory analysis. Doctors make them when there is suspicion of infection. To determine this, doctors take a sample of amniotic fluid and analyze it under a microscope.
Available treatments
Once the diagnosis of cervical insufficiency has been confirmed, there are treatments to avoid serious consequences. The goal of all of them is to delay delivery for as long as possible. Some of these are as follows.
Progesterone supplements
A study carried out by several medical centers and universities in the Netherlands pointed out that progesterone supplementation would reduce the risk of preterm birth and miscarriage, when a woman has a short cervix. The woman takes the progesterone as an injection or vaginal suppository.
Cervical cerclage
Cervical cerclage is a surgical procedure in which doctor closes the cervix with strong sutures. This cerclage is removed between weeks 36 to 38, when it is safe to give birth, since at week 37 the pregnancy is considered full term. Sometimes the suture is removed at the time of delivery.
Arabin pessary
This is a procedure in which the cervix is wrapped and closed, using a ring specially designed for this. In this case, no surgery is required. This technique is believed to be very effective when the mother has a funnel-shaped, ie, “V” shaped cervix. However, research is still lacking.
Bed rest
Bed rest, or pelvic rest, has proven to be an effective method of delaying labor. Such rest can be partial or total. In some cases, the mother may only be able to get up to eat and go to the bathroom. Although this could be very annoying, the truth is that it is a simple and proven method.
Risk factors and complications
The most obvious risk factor in these cases is cervical trauma. If there is any type of injury or surgery has been performed in the area, the possibility of failure of the cervix increases.
As we have already noted, other risk factors are congenital problems, connective tissue diseases and exposure to the drug diethylstibestrol. However, many of the women with this condition have no known risk factors.
African American women have a slightly higher risk of developing this problem. As for complications, the most obvious and serious are premature birth or the possibility of miscarriage.
Periodic birth check is essential
There is no way of knowing if a woman has cervical insufficiency unless she is pregnant. This creates a significant difficulty for the early diagnosis and treatment of this problem.
It is best to maintain continuous and efficient prenatal care. You need to report any symptoms to the doctor, even if they do not appear to be serious. It is also advisable to ask any doubts or questions you have. In this way, you reduce the risk of any sudden eventuality.
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