What is an Incompetent Cervix?
With an incompetent cervix the cervical tissue is weak and this can then cause premature labour in the second and third trimesters; if the labour begins too soon the baby will not be viable and will therefore be stillborn. The cervix is usually closed and rigid before pregnancy; however, as pregnancy progresses and begins to get ready for birth, the cervix will soften, efface (shorten) and dilate (open); with women who have an incompetent cervix this process can happen too early.
As the baby grows larger and heavier the pressure placed on the cervix is increased; in women with an incompetent cervix this can cause premature rupture of the membranes, premature delivery, early preterm delivery (before 32 weeks) and stillbirth. Cervical Incompetence occurs in approximately 1 out of 100 pregnancies.
There may not be any noticeable symptoms of an incompetent cervix; however, some people report having:
- Mild discomfort
- Spotting or bleeding
- Pelvic pressure
- Mild abdominal cramps
- A change in vaginal discharge
- Previous premature birth
- Previous miscarriage or stillbirth in the second or third trimester
- Cervical injury during a previous birth or dilation and curettage (D&C)
- Several pregnancies terminated
- You’ve had a cone biopsy or LEEP (Loop Electrosurgical Excision Procedure)
If you’re pregnant and have any risk factors for an incompetent cervix or you experience any symptoms during your second trimester, then speak to your doctor or midwife straight away as you may need urgent medical care.
Tests and Treatment
When diagnosing an incompetent cervix, the doctor will usually perform an ultrasound. If you’re less than 24 weeks gestation, your cervical opening is more than 2.5 cm, or the length has shortened to less than 20 mm, then the doctor may recommend you have a cervical cerclage (a cervical stitch). This procedure can prevent premature delivery in 85% – 90% of women. The best time to perform a cerclage is between 13 and 16 weeks, before the cervix starts to change.
Cervical cerclage is usually performed using a spinal, or epidural anaesthetic and your doctor will continue to check your cervix regularly for signs of further changes. The stitch is usually removed at around 37 weeks and once the stitch is removed, labour and delivery should proceed normally.
If you’ve had a cervical cerclage and experience any of the following symptoms, call your doctor immediately:
- Vaginal spotting or bleeding
- Your amniotic sac begins leaking or breaks
- You have a temperature over 38°C (100.4°F)
- You have signs of infection, including chills, a cough, or if you feel weak and achy
There is a fantastic Facebook page which has lots of information about cervical incompetence and is regularly updated. Please visit https://www.facebook.com/CervicalIncompetence/