Cervix is the muscular lower part of the uterus. It is firm, long and closed. During pregnancy, the lower end of the cervix is closed and as childbirth approaches, it becomes thin and short. Later, it opens up for delivery. For some women, this can open in the 2 nd trimester and it is called incompetent cervix or cervical incompetence. Complications like miscarriage or premature childbirth can happen because of this. So regular checkups and timely intervention are needed.
Cervical incompetence, also called cervical insufficiency, happens when the cervix dilates early in pregnancy. Most of the time the reason for cervical incompetence is unknown. The commonest causes of cervical incompetence are infections and a weak cervix. Infections could be localized to the vagina and cervix or any generalized infection in the body. Conditions that weaken the cervix include pressure of multiple pregnancies (twins and triplet pregnancy), injury to the cervix due to previous surgery, abnormally formed cervix or uterus or medical conditions like Ehlers-Danlos Syndrome and Marfan Syndrome.
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There is no direct test available to diagnose cervical incompetence in advance. Depending on your symptoms and previous history, your doctor would advise certain tests and examinations to confirm the possibility of cervical incompetence.
A few women may feel discomfort or mild spotting. Other signs include pressure in the pelvis, mild cramps in the belly, backache, light vaginal bleeding and a change in vaginal discharge.
Transvaginal ultrasound and a pelvic internal examination are recommended to confirm the condition and treat it accordingly. Lab tests may also be recommended to aid in the management.
The treatment modality includes medical and surgical approaches.
Medical management includes bed rest and Progesterone supplements in the form of injections and vaginal suppositories. Weight management is very important to aid in the treatment.
Surgical management includes cervical cerclage (cervical stitch). Most often cervical stitch is put on an emergency basis but in cases of the previous history, it can be planned between 14-16 weeks of pregnancy.
Ultrasounds may have to be repeated at regular intervals to assess the cervical length and modify the treatment.
It is not possible to prevent an incompetent cervix, but early detection and timely management can help prevent the possibility of preterm delivery. Do the best you can to make your pregnancy journey healthy. The foremost thing to do is to follow a healthy diet. While there is no food to avoid with an incompetent cervix you need to eat a more protein-rich diet to help increase the baby’s weight. Smoking and alcohol are to be strictly avoided. Weight management is another key aspect to reducing the pressure off the cervix and preventing adverse effects of prolonged bed rest which is needed in case of cervical incompetence.
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The cervix is meant to be closed until the time of delivery. If it opens, shortens, or weakens before the end of your pregnancy, it is an incompetent cervix. Also known as cervical insufficiency, this complication is not rare and can lead to premature birth or even a miscarriage.
One cannot strengthen their cervix through exercises, like they can strengthen other muscles. Reducing physical work that exerts pressure on the cervix and cutting back on sexual intercourse can prevent the worsening of cervical insufficiency. In case of an incompetent cervix, progesterone supplementation and a cervical cerclage can reinforce the cervix and prevent it from opening too early.
Your cervix is meant to be closed until the baby is ready to come out. If the cervix opens up or the mucus plug dislodges, it indicates cervical insufficiency. Your gynaecologist will check your cervix regularly as pregnancy progresses. The pregnancy ultrasounds throughout your pregnancy will also track the length to detect any insufficiency at the earliest.
While the opening or shortening of the cervix is one of the biggest symptoms, not everyone with an incompetent cervix experiences these symptoms. Other warning signs to watch out for are backaches, pressure on your pelvis, painful abdominal cramps, or changes in vaginal discharge.
