Pregnancy is a time when every mother has high hopes and also a little fear. We are always thinking about the baby's health and whether everything will be okay. At such a time, we are talking about a condition that you may not have heard of, but is very worth knowing about. That is cervical insufficiency, or as doctors call it , 'Incompetent Cervix' or 'Cervical Insufficiency' . Don't be afraid when you hear this name, if you are properly informed about this and get the right treatment, you can manage it without any problems in most cases.
Simply put, what is an incompetent cervix?
Think of your uterus (the sac where your baby is) as a little house. The cervix is the door to that house. This door needs to be tightly closed until your baby is fully developed, which is around 37-40 weeks. Only then can your baby stay safely inside your womb.
However, in a condition called 'Incompetent Cervix', this door starts to open without any reason or pain, around mid-pregnancy, before the baby is even fully developed. The cervix becomes weak, short, and opens.
So why is this a problem?
Imagine, what would happen if the baby's door was opened too early? The baby would have to come out. But at that time, the baby's vital organs, such as the lungs and heart, were not fully developed. This could cause two major problems:
1. Second-trimester miscarriage: The loss of a baby before 20 weeks of pregnancy.
2. Premature birth: Birth of a baby before 37 weeks.
This condition occurs in about 1 in 100 pregnancies, so it's important to be aware of it.
Who is most at risk for this condition?
This condition can happen to anyone, but some people are at higher risk. Your doctor will ask you about your health history to see if you have any of these risk factors.
| Risk factor | A simple explanation |
|---|---|
| Previous miscarriages or premature births | A major risk factor is a history of a painless miscarriage, especially in the second trimester (between weeks 14-27) in a previous pregnancy. |
| Damage to the cervix or uterus | If the cervix has been damaged due to a previous childbirth, a procedure such as a cervical tear, D&C, or other cause. |
| Cervical surgeries | After a procedure such as LLETZ or cone biopsy for cervical cancer, the cervix may become shortened or weakened. |
| Birth defects of the uterus or cervix | Some women may be born with abnormalities in the shape of their uterus or cervix, which can also cause the cervix to become weak. |
| Genetic conditions | If you have genetic diseases that weaken the body's connective tissues, such as Ehlers-Danlos syndrome , your cervix may also weaken. |
| Multiple pregnancies | This risk may also increase when multiple babies, such as twins or triplets, are in the womb at the same time, as there is more pressure on the uterus and cervix. |
The most important thing is to tell your doctor all the details about your previous pregnancies and surgeries without hiding anything . That information will help him take good care of you.
What are the symptoms of this condition?
This is the biggest challenge here. Most of the time, there are no obvious symptoms of an 'Incompetent Cervix'. There are no contractions like when you're about to give birth, and your water doesn't break. Everything happens silently.
However, some people may experience subtle symptoms like these between weeks 14 and 20:
- A feeling of pressure or heaviness in the lower abdomen.
- It feels like a slight ache in my back.
- A change in vaginal discharge (can be watery, mucus-like, or have a little blood).
- Spotting.
These symptoms are so subtle that they can sometimes be overlooked as normal pregnancy discomforts. So if you feel anything unusual, even if it's just a small thing, never hesitate to tell your doctor.
How does a doctor find this?
This condition is often diagnosed by closely monitoring a woman who has had a problem in a previous pregnancy. If you have any of the risk factors mentioned above, your doctor will take special care of you.
This can be identified in two main ways:
1. Health history: The doctor will ask you in detail about your previous pregnancies, miscarriages, and surgeries.
2. Transvaginal Ultrasound: This is the best way to diagnose this condition. In this, a small instrument is inserted through the vagina and the cervical length is precisely measured. This scan can clearly see whether the cervix is shortening or opening as the pregnancy progresses. For those at risk, the doctor may recommend repeating this scan one or two weeks after the 16th week of pregnancy and again after the 24th week.
What are the treatments and management for this?
If this condition is diagnosed, there are several treatments that can be used to prolong the baby's time in the womb, which can help prevent premature birth. Your doctor will determine the most appropriate treatment for you based on your condition and health history.
| Treatment method | Description |
|---|---|
| Cervical Cerclage | This is the most commonly used and most successful method. Simply put, a strong suture is placed around the weakened cervix and tightened to close it. It's like a bag that ties the cervix shut. This surgery is usually done between 12 and 14 weeks. Then, when the baby is close to being born, around 37 weeks, the sutures are cut and removed. |
| Progesterone hormone therapy (Progesterone supplements) | Progesterone is a hormone that helps maintain pregnancy. For those with a history of preterm birth, this hormone can be given as a pill or as a vaginal suppository starting in the second trimester. This helps reduce uterine contractions and keep the cervix strong. |
| Constant monitoring | If there is a risk, but the condition is not severe enough to require stitches, your doctor will perform regular scans to monitor your cervix for any changes in length. If any changes are noticed, the necessary treatment can be started immediately. |
Can everyone have a cerclage?
No. There are some cases where this surgery is not recommended. For example:
- If you have twins or more.
- If the cervix is already more than 4 centimeters dilated.
- If the membranes have ruptured.
- If there is an infection in the uterus.
At times like this, your doctor will talk to you about other options.
Can you think about your next pregnancy?
Yes, it is definitely possible. But if you had an 'Incompetent Cervix' in one pregnancy, you are at risk of having the same condition in your next pregnancy. Therefore, before you think about having another baby, meet with your gynecologist and discuss this. Then, you can be closely monitored from the beginning of your next pregnancy and, if necessary, take steps such as placing a stitch (cerclage) early.
The good news is that cerclage is about 90% successful. That means you have a good chance of keeping your baby until the due date. So don't worry.
When you should see a doctor immediately
Whether or not you are receiving treatment for this condition, it is essential to seek immediate medical advice if you experience anything unusual during pregnancy. Especially if you have the following symptoms, call your doctor immediately or go to the nearest hospital Emergency Department (ETU).
- If there is a liquid like blood or water coming out of the vagina.
- If you feel pain in your lower abdomen or contractions.
- If you experience unusual back pain.
- If you feel pressure in your lower abdomen.
Take-Home Message
- 'Incompetent Cervix' is when the cervix becomes weak and begins to open before the baby is fully developed. This is a major cause of premature birth.
- Most of the time, there are no obvious symptoms of this condition, so it's very important to tell your doctor all the details about your previous miscarriages and surgeries.
- A transvaginal ultrasound scan can detect cervical dilation early.
- Cervical cerclage is a very effective treatment for this.
- If you have any doubts or concerns about this, don't hesitate to discuss it with your doctor. Your safety and that of your baby are the most important thing.
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