Description of Cervical Incompetence: Cervical incompetence is a condition in which the cervix begins to open (dilate) and thin (efface) before the pregnancy has reached term. Occurring in the second or third trimester, cervical incompetence is a cause of late miscarriage and premature birth. When a cervix is incompetent, the muscle of the cervix is weak and the pressure of the growing baby causes the weak cervix to open. There are no contractions. If a woman is known to have a weak cervix (usually because of a problem in a prior pregnancy), measures can be taken to reduce the risk of miscarriage or premature birth in subsequent pregnancies.
Incidence/Prevalence of Cervical Incompetence: Cervical incompetence occurs in only 1% to 2% of all pregnancies. It is the cause of 20-25% of miscarriages in the second trimester.
Signs and Symptoms of Cervical Incompetence: vaginal bleeding or spotting Pressure or heaviness in the lower abdomen.
Risk Factors for Cervical Incompetence: Previous surgical procedure involving the cervix, including a D&C or a biopsy Malformation of the cervix Maternal exposure to DES while in utero Damage to the cervix during a prior difficult delivery Multiple gestation.
Diagnosis of Cervical Incompetence: Unfortunately, there is no way to diagnose cervical incompetence before a pregnancy. If a woman is diagnosed with cervical incompetence during one pregnancy, she has an incompetent cervix which is a factor in subsequent pregnancies.
Treatment of Cervical Incompetence: If a cervix begins to dilate and the problem is caught early, the physician may try to delay birth. If measures fail, miscarriage or premature birth will occur. Unfortunately, in most cases after the cervix begins to dilate, medical science cannot sustain the pregnancy for very long, although measures will be taken to delay birth in order to help the fetus’ lungs mature. If a woman has been diagnosed with cervical incompetence in a previous pregnancy, the physician may stitch the cervix to keep the opening closed during subsequent pregnancies. In a procedure called cerclage, sutures are placed above the opening of the cervix to narrow the canal and reinforce the cervical muscle. The sutures may stay in place or be removed as the pregnancy approaches term, depending on the type of cerclage that was used. Generally, cerclage is done before 20 weeks of pregnancy. Even with cerclage, a woman with an incompetent cervix has a 25% risk for preterm birth. Commonly, a woman requires bed rest and treatment for preterm labour during the pregnancy.