Incompetent cervix or cervical insufficiency frequently presents with no symptoms.
During the second trimester of pregnancy, the most common sign of an incompetent cervix is painless cervical dilation and bulging fetal membranes. Expectant mothers, on the other hand, are often unable to feel this at all.
Subtle indicators, like the ones below, can appear from time to time.
6 possible signs of incompetent cervix
- Increased or mucous vaginal discharge/change on the vaginal discharge:
- Though vaginal discharge is common in pregnant and nonpregnant women, it's still a good idea to keep an eye on things. A change in discharge could indicate a cervix that isn't functioning properly.
- Look for signs such as an increase in quantity, change in color, or a strange texture. Few women report a vaginal gush of warm liquid as a sign of an incompetent cervix.
- Vaginal spotting or bleeding:
- Light spotting can be a sign of an incompetent cervix. A small amount of bleeding could be nothing or something serious, so always consult your doctor if there is blood during pregnancy.
- Increased pelvic pressure:
- Usually occurs between 14 and 20 weeks of pregnancy, but it can happen at any time.
- Regular uterine cramps or mild contractions:
- Abdominal cramping is a broad term that covers a wide range of problems. However, certain symptoms, such as premenstrual cramping, may be indicative of cervical insufficiency.
- If you notice anything unusual about your cramps, don't hesitate to contact a medical professional.
- Lower back pain radiating to the lower abdomen:
- Although back pains are fairly common during pregnancy, they rarely occur in the early stages. Such back pain can be a symptom of cervical insufficiency. Again, there isn't a hard and fast rule for a sore back and incompetent cervix.
- Consult your physician to rule out an incompetent cervix.
- Preterm labor:
- Preterm labor is more likely in women who have a short or incompetent cervix. Premature labor may be indicated by regular contractions before 37 weeks.
- Regular contractions follow a pattern in terms of timing. For instance, if you have a contraction every 10 to 12 minutes for more than an hour, you may be in preterm labor.
Cervical insufficiency has no clinical signs or symptoms of its own, and the diagnosis is usually made after a fetal loss in the second or early third trimester.
- The typical history consists of two or more losses, each occurring at a later gestational age. These occur following a silent dilatation of the cervix with no painful contractions or heavy bleeding.
- Cervical insufficiency is difficult to diagnose during a woman's first pregnancy because symptoms are subtle or even absent.
- Cervical insufficiency is sometimes discovered when a woman goes to the doctor for a routine second-trimester ultrasound and the ultrasound shows that her cervix is one to two centimeters dilated.
- During the ultrasound, most women are unaware that there is a problem.
What is incompetent cervix?
Cervical incompetence is a common cause of repeated pregnancy loss.
In a typical pregnancy, the cervix remains tightly closed until it is time to give birth. The cervix then begins to soften, shorten, and dilate (open) in preparation for birth under hormonal influence.
If you have cervical incompetence, your cervix may undergo these changes (softening, shortening, and dilating) well before you give birth. When this occurs, the cervix may not be strong enough to support the growing fetus, putting the pregnancy at risk. Most women who miscarry as a result of cervical incompetence lose the pregnancy around 20 weeks.
The cause of cervical incompetence is unknown, but it is thought to be caused by a physical weakness in the woman's cervix, which makes it susceptible to giving way as the baby grows larger and heavier, putting increased pressure on the cervix as the pregnancy progresses. Both genetic and environmental factors are thought to play a role.
Risk factors for cervical incompetence
The length of the cervix is affected by several factors, including:
- Over-distended uterus (a term meaning that the uterus has been stretched too far)
- Bleeding during pregnancy
- Inflamed uterine lining
- Certain infections
Risk factors for cervical incompetence include:
- Previous losses:
- Women who have miscarried twice or more in the second trimester appear to be at a higher risk for cervical insufficiency.
- Collagen disorders:
- Ehlers–Danlos syndrome and Marfan's syndrome, which affect collagen (a protein in the body that gives skin and tissues strength and elasticity), can increase risk.
- Gynecologic history:
- Cervical trauma:
- Some surgical procedures used to treat cervical abnormalities caused by an abnormal Papanicolaou smear can result in cervical insufficiency.
- Other procedures, such as dilation and curettage, may be linked to cervical insufficiency.
- Congenital conditions:
- An incompetent cervix can be caused by uterine abnormalities and genetic disorders that affect the body's connective tissues.
- Furthermore, prenatal exposure to synthetic estrogen has been linked to cervical insufficiency.
- Cervical insufficiency appears to be more common in African-American women, although the reason needs more research.
- Increased maternal age:
- Because of aging, the muscles surrounding the cervix begin to lose elasticity, which may contribute to the cervix's weakening.
- Other causes:
- Being pregnant with more than one baby (twins or triplets)
- Birth trauma
- A previous forceps delivery
Women may be classified as high or low risk for cervical shortening or incompetence based on the factors listed above, and this will influence how they are treated.
- History of a previous painless miscarriage between 12 and 24 weeks
- Premature delivery
- Surgery to the cervix
If your doctor determines that you are at high risk of having a short or weak cervix based on your medical, surgical, and obstetric history, she may recommend:
- As part of your first-trimester screening, you will have a transvaginal ultrasound to determine the length of your cervix.
- If they are diagnosed with an abnormal cervix, they may be offered medication or a surgical procedure to treat it.
- They may also require additional ultrasounds to determine the length of the cervix, which is most commonly done at 18 to 20 weeks and again at 24 weeks. Scans may also be required at other times.
- There is no prior history of early delivery, but an ultrasound or vaginal examination demonstrates a short cervix in their current pregnancy.
Women who do not have any risk factors for cervical incompetence or a short cervix are advised to have:
- At 18 to 20 weeks gestation, a transvaginal ultrasound is used to determine the length of the cervix.
- If the cervix is larger than 25 mm, no further ultrasound is required.
- If the cervix is shorter than 25 mm, treatment with medications or a surgical procedure may be discussed.
- Patients may also require additional ultrasounds to measure the length of the cervix, which would most commonly occur every two weeks until 24 to 28 weeks.
An incompetent cervix can endanger your pregnancy, especially in the second trimester. Premature birth and unexpected pregnancy loss are the most serious consequences of cervical insufficiency.
If cervical incompetence is detected early, doctors will closely monitor the fetus and cervix to prevent premature birth and miscarriage. Premature birth can result in a variety of neonatal risks and birth injuries, including brain damage to infants.
What are the treatment options for incompetent cervix?
Miscarriage does not have to be your constant companion even if you have cervical incompetence. Doctors offer a variety of options to help women suffering from the condition carry their pregnancies to term, including:
- Reducing your activity level near the end of your pregnancy may help reduce your risk of the cervix opening prematurely. However, it may not be effective in every patient.
- Progesterone injections to supplement your body's progesterone levels may help delay cervical changes.
- A vaginal pessary containing 200 mg of progesterone is inserted each night before bed for women who are recommended to use this treatment option.
- Because of the outer coating of the pessary, it is common to have vaginal discharge when using this medication, and there may be mild vaginal irritation.
- If this occurs, the suppositories can also be used rectally.
- Long-term progesterone use in pregnancy is considered very safe, and there is no increased risk of major birth defects in babies born to women who use progesterone in this way.
- Male babies born to progesterone-using mothers have a slight increase in hypospadias, a condition in which the urethra does not end in the center of the penis.
- Physically stitching the cervix closed at the start of the second trimester (around 14 weeks) can help ensure that your cervix remains closed until delivery.
Surgical approaches include:
- Transvaginal cervical cerclage
- Transabdominal cervical cerclage
In most cases, transvaginal cerclage is the first treatment option to be considered, and transabdominal or laparoscopic approaches are limited to specific situations. Cervical cerclage is an outpatient procedure performed under regional anesthesia. When the due date is near, these stitches are removed.
There are two different types of cerclage techniques:
- McDonald: Stitches are placed through the cervix with a needle. The suture ends are tied together to form a purse-string closure.
- Shirodkar: This method entails dissecting around the cervix and placing stitches around it to keep it closed.
A transabdominal cerclage is an option for complicated cases, including those in which the cervical cerclage has previously failed. This procedure entails making one or more abdominal incisions to reach the cervix and then stitching it closed.
Side effects of cervical cerclage
Cervical cerclage has some risks, just like any other surgery. These risks are uncommon, and your medical team will take every precaution to ensure that the procedure is carried out safely.
Cervical cerclage may result in the following complications:
- Uterine rupture
- Maternal hemorrhage
- Bladder rupture
- Cervical laceration
- Preterm labor
- Premature rupture of the membranes
The likelihood of the above risks is very minimal. Some other risks include
- Damage to the cervix
- Maternal hemorrhage
- Preterm labor
- Preterm premature rupture of membranes: Amniotic sac rupture
- Cervical stenosis (narrowing or hardening of the cervix)
- Tearing in the cervix or uterine tissue, if you go into labor with the stitches still in place
An incompetent cervix can't be diagnosed until you're already pregnant and experiencing symptoms, but you can keep an eye out for any of the symptoms listed above and speak with your doctor if you have any concerns. You and your doctor can make the best effort to avoid preterm birth with close monitoring and possibly a treatment plan.
If you may believe that you contributed to the premature birth, talk to your partner and loved ones, as well as your doctor, if you're experiencing guilt. Concentrate your efforts on caring for and learning about your child.
Cervical insufficiency and short cervix: https://www.marchofdimes.org/complications/cervical-insufficiency-and-short-cervix.aspx
Incompetent cervix: weakened cervix: https://americanpregnancy.org/getting-pregnant/incompetent-cervix/
Cervical incompetence: https://www.ncbi.nlm.nih.gov/books/NBK525954/
Incompetent cervix: https://www.birthinjuryhelpcenter.org/cervical-incompetence.html
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