Cervical Insufficiency

ExitCare ImageCervical insufficiency is when the cervix is weak and starts to open (dilate) and thin (efface) before the pregnancy is at term and without labor starting. This is also called incompetent cervix. It can happen in the second or third trimester when the fetus starts putting pressure on the cervix. Cervical insufficiency can lead to a miscarriage, preterm premature rupture of the membranes (PPROM), or having the baby early (preterm birth).

RISK FACTORS

You may be more likely to develop cervical insufficiency if:

  • You have a shorter cervix than normal.

  • Damage or injury occurred to your cervix from a past pregnancy or surgery.

  • You were born with a cervical defect.

  • You have had procedure done on the cervix, such as cervical biopsy.

  • You have a history of cervical insufficiency.

  • You have a history of PPROM.

  • You have ended several past pregnancies through abortion.

  • You were exposed to the drug diethylstilbestrol (DES).

SYMPTOMS

Often times, women do not have any symptoms. Other times, woman may only have mild symptoms that often start between week 14 through 20. The symptoms may last several days or weeks. These symptoms include:

  • Light spotting or bleeding from the vagina.

  • Pelvic pressure.

  • A change in vaginal discharge, such as discharge that changes from clear, white, or light yellow to pink or tan.

  • Back pain.

  • Abdominal pain or cramping.

DIAGNOSIS

Cervical insufficiency cannot be diagnosed before you become pregnant. Once you are pregnant, your caregiver will ask about your medical history and if you have had any problems in past pregnancies. Tell your caregiver about any procedures performed on your cervix or if you have a history of miscarriages or cervical insufficiency. If your caregiver thinks you are at high risk for cervical insufficiency or show signs of cervical insufficiency, he or she may:

  • Perform a pelvic exam. This will check for:

  • The presence of the membranes (amniotic sac) coming out of the cervix.

  • Cervical abnormalities.

  • Cervical injuries.

  • The presence of contractions.

  • Perform an ultrasonography (commonly called ultrasound) to measure the length and thickness of the cervix.

TREATMENT

If you have been diagnosed with cervical insufficiency, your caregiver may recommend:

  • Limiting physical activity.

  • Bed rest at home or in the hospital.

  • Pelvic rest, which means no sexual intercourse or placing anything in the vagina.

  • Cerclage to sew the cervix closed and prevent it from opening too early. The stitches (sutures) are removed between weeks 36 and 38 to avoid problems during labor.

Cerclage may be recommended during pregnancy if you have had a history of miscarriages or preterm births without a known cause. It may also be recommended if you have a short cervix that was identified by ultrasound or if your caregiver has found that your cervix has dilated before 24 weeks of pregnancy. Limiting physical activity and bed rest may or may not help prevent a preterm birth.

WHEN SHOULD YOU SEEK IMMEDIATE MEDICAL CARE?

Seek immediate medical care if you show any symptoms of cervical insufficiency. You will need to go to the hospital to get checked immediately.