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Insufficient cervix
Incompetent cervix; Weak cervix; Pregnancy - insufficient cervix; Premature labor - insufficient cervix; Preterm labor - insufficient cervixThe cervix is the narrow lower end of the uterus that goes into the vagina.
- In a normal pregnancy, the cervix stays firm, long, and closed until late in the 3rd trimester.
- In the 3rd trimester, the cervix starts to soften, get shorter, and open up (dilate) as a woman's body prepares for labor.
An insufficient cervix may begin to dilate too early in pregnancy. If there is an insufficient cervix, the following problems are more likely to occur:
- Miscarriage in the 2nd trimester
- Labor begins too early, before 37 weeks
- Bag of waters breaks before 37 weeks
- A premature (early) delivery
- What Causes it?
No one knows for sure what causes an insufficient cervix, but these things may increase a woman's risk:
- Being pregnant with more than 1 baby (twins, triplets)
- Having an insufficient cervix in an earlier pregnancy
- Having a torn cervix from an earlier birth
- Having past miscarriages by the 4th month
- Having past late-term abortions
- Having a cervix that did not develop normally
- Having a cone biopsy or loop electrosurgical excision procedure (LEEP) on the cervix in the past due to an abnormal Pap smear
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- How do I Know I Have it?
Often, you will not have any signs or symptoms of an insufficient cervix unless you have a problem it might cause. That is how many women first find out about it.
If you have any of the risk factors for insufficient cervix:
- Your health care provider may do an ultrasound to look at your cervix when you are planning a pregnancy, or early in your pregnancy.
- You may have physical exams and ultrasounds more often during your pregnancy.
An insufficient cervix may cause these symptoms in the 2nd trimester:
- Abnormal spotting or bleeding
- Increasing pressure or cramps in the lower abdomen and pelvis
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- How is it Treated?
If you have an insufficient cervix, your provider will likely suggest bed rest. During bed rest, you will be advised not to have sex. Your provider may suggest you have a cerclage. This is a surgery to treat an insufficient cervix. During a cerclage:
- Your cervix will be stitched closed with a strong thread for the whole pregnancy.
- You will be given medicine to prevent a miscarriage that could occur from the surgery.
- Your stitches will be removed near the end of the pregnancy, or sooner if labor begins early.
Cerclages work well for many women.
Sometimes, medicines such as progesterone are prescribed instead of a cerclage. These help in some cases.
Talk with your provider about your situation and treatment options.
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References
Berghella V, Iams JD. Cervical insufficiency. In: Creasy RK, Resnik R, Iams JD, Lockwood CJ, Moore TR, Greene MF, eds. Creasy and Resnik's Maternal-Fetal Medicine: Principles and Practice. 7th ed. Philadelphia, PA: Elsevier Saunders; 2014:chap 41.
Ludmir J, Owen J, Berghella V. Cervical insufficiency. In: Gabbe SG, Niebyl JR, Simpson JL, et al, eds. Obstetrics: Normal and Problem Pregnancies. 7th ed. Philadelphia, PA: Elsevier; 2017:chap 28.
