CERVICAL
INCOMPETENCE
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DEFINITION
Cervical insufficiency is the inability of the cervix to retain
fetus, in the absence of uterine contractions or labor
(painless cervical dilatation), owing to a functional or
structural defect. It is cervical ripening that occurs far from
the term. Cervical insufficiency is rarely a distinct and well
defined clinical entity but only part of a large and more
complex spontaneous preterm birth syndrome. It can cause
problems including miscarriage (loss of the pregnancy) and
premature birth (being born before 37 weeks of pregnancy).
WHAT CAUSES CERVICAL
INCOMPTENCE
An incompetent cervix can be difficult to diagnose and
treat. Healthcare experts haven’t identified an exact
cause for incompetent cervix. However, they know
certain factors can put you at risk. These risk factors
include damage to your cervix, prior surgeries to your
cervix or being born with an irregularly-shaped cervix or
uterus.
Who is at risk for incompetent cervix?
ANYONE CAN DEVELOP AN INCOMPETENT CERVIX. HOWEVER, YOU
MAY BE AT HIGHER RISK IF YOU HAVE:
AN IRREGULARLY SHAPED CERVIX OR UTERUS.
EXPERIENCED A PREMATURE BIRTH OR MISCARRIAGE IN
THE SECOND TRIMESTER OF PREGNANCY.
INJURED YOUR CERVIX OR UTERUS DURING A PREVIOUS
PREGNANCY OR CHILDBIRTH.
HAD SURGERY ON YOUR CERVIX.
A GENETIC DISORDER LIKE EHLERS-DANLOS SYNDROME
WHICH MAY CAUSE CERVICAL WEAKNESS AND CAN LEAD
TO CERVICAL INSUFFICIENCY.
TESTS AND PROCEDURES TO
HELP DIAGNOSE
an incompetent cervix
Transvaginal ultrasound. Your doctor may use transvaginal ultrasound to evaluate
the length of your cervix and to check if membranes are protruding through the
cervix. During this type of ultrasound, a slender transducer is placed in your vagina to
send out sound waves that generate images on a monitor.
Pelvic exam. Your doctor will examine your cervix to see if the amniotic sac has
begun to protrude through the opening (prolapsed fetal membranes). If the fetal
membranes are in your cervical canal or vagina, this indicates cervical insufficiency.
Your doctor will also check for contractions and, if necessary, monitor them.
Lab tests. If fetal membranes are visible and an ultrasound shows signs of
inflammation but you don't have symptoms of an infection, your doctor might test a
sample of amniotic fluid (amniocentesis) to diagnose or rule out an infection of the
amniotic sac and fluid (chorioamnionitis).
SIGNS & SYMPTOMS
A sensation of pelvic
pressure
A new backache
Mild abdominal cramps
A change in vaginal
discharge
Light vaginal bleeding
WAYS TO PREVENT,
AVOID AND LESSEN
COMPLICATION
You can't prevent an incompetent cervix — but there's much you can do to promote a healthy, full-term
pregnancy. For example:
Seek regular prenatal care. Prenatal visits can help your doctor monitor your health and your baby's
health. Mention any signs or symptoms that concern you, even if they seem silly or unimportant.
Eat a healthy diet. During pregnancy, you'll need more folic acid, calcium, iron and other essential
nutrients. A daily prenatal vitamin — ideally starting a few months before conception — can help fill any
dietary gaps.
Gain weight wisely. Gaining the right amount of weight can support your baby's health. A weight gain
of 25 to 35 pounds (about 11 to 16 kilograms) is often recommended for women who have a healthy
weight before pregnancy.
Avoid risky substances. If you smoke, quit. Alcohol and illegal drugs are off-limits, too. In addition, get
your doctor's OK before taking any medications or supplements — even those available over-the-
counter.
TREATMENT
Cervical cerclage
A procedure called a cervical cerclage is one way pregnancy care providers try to
prevent premature labor. It involves sewing your cervix shut. Cerclage procedures
typically happen at around 12 to 14 weeks of pregnancy. Then, around 37 weeks of
pregnancy, your provider removes the stitches so a vaginal delivery is possible.
Progesterone supplements
If you have a history of premature birth, your doctor might suggest weekly shots of a
form of the hormone progesterone called hydroxyprogesterone caproate (Makena)
during your second and third trimester.
Increased monitoring with ultrasound
If you have risk factors for cervical insufficiency, your pregnancy care provider may
decide to monitor the length of your cervix using ultrasound up until about 24
weeks of pregnancy.
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