Cervical insuffiency – when the cervix dilates without contractions – is so painless that you might not even know it’s happening until it’s too late, especially if it’s your first pregnancy.
If not caught, cervical insufficiency can lead to preterm birth or miscarriage.
The good news? There are ways to spot cervical insufficiency before it progresses too far, and treatments may help prolong the pregnancy of a woman with cervical insufficiency as close to full term as possible.
In the past, “incompetent cervix” was the term used to describe the shortening and painless dilation of the cervix that can lead to preterm birth. These days, doctors use the term “cervical insufficiency” to describe the same complication.
While cervical insufficiency isn’t usually detected until seen on an ultrasound or until a woman experiences downward pressure in her pelvis that signals dilation and movement of the fetus into the birth canal, there are ways doctors may be able to mitigate the risks of this condition and keep the baby in place as long as possible.
What Is Cervical Insufficiency?
The cervix is the opening of the uterus into the vagina, forming the birth canal. During pregnancy, the cervix normally stays firm and closed until late in the third trimester. In preparation for the baby’s birth, the cervix becomes thinner and softer, shortens and dilates, creating an opening for the baby to pass through during delivery.
About 1 in 100 pregnancies are affected by cervical insufficiency — defined as painless, cervical dilation in the absence of persistent uterine contractions. Ultimately, the cervix weakens and will soften and open too early in the pregnancy.
Why Cervical Insufficiency Happens
There are several factors that may cause cervical insufficiency, including:
- Biological makeup and how the cervix interacts with the hormones produced in a pregnancy.
- Past cervical trauma, including injury or past cervical surgery, such as to remove pre-cancerous or cancerous cells. This has become somewhat less common in recent years, as many women are now vaccinated against the human papillomavirus (HPV) that has been linked to cervical cancer.
- Genetics may also play a role. It’s difficult to predict who will experience cervical insufficiency. But if you have family members who have had cervical insufficiency, your doctor may take preventative measures.
The best-case scenario for diagnosing cervical insufficiency is that your OB-GYN spots signs of early cervical change during the mid-pregnancy ultrasound, which usually occurs at 20 weeks. If they suspect cervical insufficiency, a transvaginal ultrasound can accurately evaluate the cervix and its length. Based on what they see on the ultrasound, or if there is any history of cervical insufficiency, they may choose to monitor the situation or move directly to treatment.
Treatment Options for Cervical Insufficiency
Depending on how advanced the cervical insufficiency is, the first option your doctor would likely recommend if it’s your first pregnancy would be progesterone vaginal suppositories. Progesterone is a hormone that can help stabilize the structure of the cervix and reduce inflammation, potentially preventing cervical insufficiency from progressing. These suppositories are typically inserted before bed so they can dissolve and absorb overnight.
If progesterone treatment fails, or you have an obstetric history consistent with cervical insufficiency, transvaginal cerclage placement may be an option. This is a procedure in which the weakened cervix is stitched shut through the opening of the vagina. This may help to prevent premature cervical dilation and preterm delivery. This is usually performed during the 12th to 14th week of pregnancy. A transvaginal cerclage stitch is typically removed at about 37 weeks of pregnancy in anticipation of a vaginal delivery.
For women who have no cervix or a history of cervical insufficiency with previous unsuccessful vaginal cerclage placement, including those who have experienced pregnancy loss, a transabdominal cerclage may be considered. This is a surgical procedure in which the cervix is accessed through an incision in the lower abdomen. The cervix is then encircled with a stitch to reinforce it and help ensure that it remains closed during the pregnancy.
This procedure can be performed before or during the pregnancy. If performed during pregnancy, transabdominal cerclage placement will typically be done between the ninth and 14th week. Transabdominal cerclages require a cesarean section delivery for every pregnancy going forward and are normally kept in place until a woman reaches the end of her childbearing years.
After a cerclage is placed, women will likely be placed on “pelvic rest” until the baby is born. This means nothing should stimulate uterine contraction, including orgasm. While it’s a good idea to stay off your feet and rest whenever possible with a cerclage, it’s likely that you can still go to work and perform basic activities.
Cervical Insufficiency Is Unpredictable
Although there are no guarantees, cerclage can be very effective at helping women with cervical insufficiency prolong their pregnancies. It’s possible for a woman with a cerclage to make it to 39+ weeks of pregnancy. A woman with a vaginal cerclage may still have the option of delivering vaginally. In this case, a vaginal cerclage is typically removed at 37 weeks to ensure that labor does not begin while it’s still in place, because damage can be done to the cervix if the cerclage remains present during labor. If an abdominal cerclage was placed, the patient will be scheduled to deliver via cesarean section at 37-39 weeks of pregnancy.A diagnosis of cervical insufficiency can be scary, but there are treatment options that can help keep you and your baby safe. Your doctor will guide you through the process, supporting you every step of the way.
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