An Incompetent Cervix May Cause Pregnancy Loss Or Premature Birth. Here's How to Prevent It

If you read your ultrasound reports during pregnancy, it usually contains not just details about the baby in your womb, but also about your reproductive health. It shows the state of your uterus, ovaries, and cervix.

The cervix is one important part of your reproductive system, especially during pregnancy. In Filipino, a woman’s cervix is called "kwelyo ng matres." It’s the lower part of the uterus which connects it to the vagina. It’s typically two to five centimeters long and roughly cylindrical in shape.

The cervix acts as the doorway to the uterus, where sperm travels through to fertilize an egg. The mucus the cervix produces changes in consistency during the duration of the menstrual cycle to prevent or promote pregnancy. (Read here how you can use cervical mucus to prevent or promote pregnancy.)

If you’re not pregnant, the cervix helps keep possible infection carriers, such as tampons and bathwater, outside of your womb. But it can also get infected with sexually transmitted infections. Certain types of the human papillomavirus (HPV) is the most common cause of cervical cancer.

When you’re pregnant, the cervix helps prevent preterm labor by keeping the baby in place until it’s fully developed. During childbirth, it softens and opens to allow the baby to pass through. (Click here to see how wide your cervix opens when you give birth.)

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Incompetent cervix and what it means for your pregnancy

One to two in 100 pregnancies is made more complicated by an incompetent cervix, and about 20% to 25% of pregnancy losses that happen in the second trimester is due to an incompetent cervix. It’s also sometimes called a weakened cervix or cervix insufficiency.

An incompetent cervix happens when as the baby grows and gets heavier, it presses on the cervix and may start to soften and open up, usually painlessly and without contractions, before the baby is ready to be born. According to the American Pregnancy Association, an incompetent cervix may be caused by the following:

• Previous surgery on the cervix
• Damage to the cervix during a difficult birth
• Past trauma to the cervix, such as dilation and curettage from termination of pregnancy or miscarriage
• A congenital malformation of the cervix or uterus
• Exposure to diethylstilbestrol, a synthetic form of the female hormone estrogen, which was prescribed to pregnant women between 1940 and 1971 to prevent miscarriage, premature labor, and other related pregnancy complications

Diagnosing an incompetent cervix

It’s difficult to detect an incompetent cervix during a first pregnancy. Unfortunately, many women only know about having one after suffering a miscarriage in the second or third trimester of pregnancy.

Be sure to tell your doctor if you’ve had any history of second-trimester pregnancy loss or any of the possible causes mentioned above. Don’t hesitate to tell your doctor if you feel the following between Week 14 and Week 20 of your pregnancy:

• any mild discomfort
• spotting
• a feeling of pelvic pressure
• a new backache
• mild cramps in your belly (abdomen)
• a change in vaginal discharge
• light vaginal bleeding

Once you’ve communicated these to your doctor, there are ways to determine if you have signs of having an incompetent cervix. Your doctor may ask you to do a transvaginal ultrasound, pelvic exam, or a laboratory test.

Transvaginal ultrasound

During pregnancy, your cervix shortens as you near your delivery date. A transvaginal ultrasound can measure your cervix length. If your cervical length is short or less than 2.5 centimeters before 24 weeks of pregnancy, it may be caused by incompetent cervix and may be prone to dilation and increases your risk for pregnancy loss or preterm labor and delivery.

Pelvic exam

With a pelvic exam, your doctor may see if the amniotic sac has begun to protrude through the opening of the uterus. Fetal membranes, or the two-layer tissue that surrounds the fetus during pregnancy, present in your cervix or vagina indicate cervical insufficiency.

Laboratory test

According to the Mayo Clinic, a doctor may perform amniocentesis between Week 15 and Week 18 of your pregnancy. It’s a diagnostic procedure where doctors take a sample of the amniotic fluid, or the pool of liquid where your unborn baby swims in inside your womb. An amniocentesis can help rule out chorioamnionitis, an infection of the amniotic sac if the fetal membranes are visible and an ultrasound shows signs of inflammations, but symptoms of any infection are also absent.

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Managing or treatment for an incompetent cervix

If you’re diagnosed with an incompetent cervix, and it’s starting to shorten, with or without symptoms of preterm labor, there are treatments your doctor may use to manage your incompetent cervix.

Cervical cerclage

Your doctor may also perform a cervical cerclage, a surgical procedure wherein the cervix is stitched closed with strong sutures. It’s typically performed between Week 14 to Week 16 of the pregnancy and has  an 80% to 90% success rate. The sutures will be removed during the last month of pregnancy or during labor.

Cervical cerclage is typically not recommended for women who are pregnant with twins, and prone to irritation of the cervix. It’s also not done if your cervix has dilated up to four centimeters, or your amniotic sac has ruptured.

As with any procedure, there are some risks involved when performing a cervical cerclage. These include uterine rupture, maternal hemorrhage, bladder rupture, cervical laceration, preterm labor, and premature rupture of the membranes.

Progesterone suppositories

The hormone progesterone helps prepare your body for pregnancy and prevents premature birth. Your doctor may prescribe progesterone vaginal suppositories that you just insert in your vagina every day, starting at 20 weeks. When you reach 37 weeks, your doctor will ask you to stop it since you’re about to give birth.

Some doctors may also recommend a pessary, a device that fits inside the vagina that holds the uterus in place. It helps lessen the pressure on the cervix. Whatever treatment you get, you’ll probably be on restricted activity until you get to term.

Prevention of incompetent cervix

There is no way to prevent having an incompetent cervix, but you can help your doctor detect it earlier so he or she can safeguard your pregnancy against miscarriage or premature birth. Even if there’s no way to prevent it, you can still carry your baby to term. The Mayo Clinic suggests the following tips.

• Don’t skip prenatal visits that help your doctor monitor your health and your baby’s health. It’s not the venue to by shy, so tell your doctor any signs or symptoms that concern you, even if they seem silly or unimportant.
• Eat a healthy diet and take your prenatal vitamins regularly. You’ll need more folic acid, calcium, iron, and other essential nutrients.
• Gain the right amount of weight to support your baby’s growth. A weight gain of 25 to 35 pounds is often recommended for women who have a healthy weight before pregnancy.
• Avoid smoking, alcohol, and other risky substances. Always consult your doctor before taking any medications or supplements.

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