Cervical Insufficiency (Incompetent Cervix)
Cervix opens too early in pregnancy without contractions, risking preterm birth.
Affects: 1-2% of pregnancies
Overview
Cervical insufficiency means the cervix begins to open (dilate) and thin (efface) too early in pregnancy, usually in the second trimester, without contractions or labor signs. This can lead to preterm birth or loss.
The condition is often diagnosed after a pregnancy loss or discovered during routine ultrasound. Risk factors include previous cervical surgery, damage during previous birth, or congenital weakness.
Treatment includes cervical cerclage (stitching the cervix closed), progesterone supplementation, and close monitoring. With treatment, many women carry to term.
🩺 Symptoms
- •Often no symptoms until cervix opens significantly
- •Mild discomfort or cramping in second trimester
- •Backache
- •Pelvic pressure
- •Change in vaginal discharge
- •Light vaginal bleeding
- •May feel like period starting
- •Usually discovered on ultrasound
🔍 Causes
- →Exact cause often unknown
- →Congenitally short or weak cervix
- →Previous cervical trauma
- →Damage from previous delivery
- →Multiple D&C procedures
- →Cervical surgery (LEEP, cone biopsy)
- →DES exposure in utero
- →Uterine abnormalities
⚠️ Risk Factors
- •Previous second trimester loss
- •Previous preterm birth
- •Cervical surgery (LEEP, cone biopsy, cryotherapy)
- •Multiple pregnancy
- •DES exposure
- •Uterine abnormalities
- •Cervical trauma
🔬 Diagnosis
- →History of second trimester loss
- →Transvaginal ultrasound measuring cervical length
- →Cervix shortening (less than 25mm before 24 weeks)
- →Cervix opening without contractions
- →Physical exam showing dilated cervix
- →Serial ultrasounds to monitor
💊 Treatment
- ✓Cervical cerclage (stitch placed 12-14 weeks)
- ✓Removed at 36-37 weeks or if labor begins
- ✓Progesterone suppositories or injections
- ✓Activity restriction or bed rest
- ✓Pelvic rest (no sex)
- ✓Regular cervical length monitoring
- ✓May need hospitalization if severe
- ✓Cerclage not appropriate for all cases
🛡️ Prevention
- →Cannot always be prevented
- →Avoid unnecessary cervical procedures
- →If known risk, early cerclage placement
- →Close monitoring in subsequent pregnancies
- →Progesterone supplementation
⚠️ Potential Complications
- !Preterm birth
- !Pregnancy loss in second trimester
- !Water breaking early (PPROM)
- !Infection
- !Cervical tears during delivery
- !Cerclage complications (infection, rupture of membranes)
- !Emotional trauma from losses
🚨 When to Call Your Doctor
Contact your healthcare provider immediately if you experience:
- ⚠Pelvic pressure in second trimester
- ⚠Backache
- ⚠Change in discharge
- ⚠Mild cramping
- ⚠Anything that feels "off"
- ⚠After cerclage: Contractions, bleeding, fever, leaking fluid
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This information is for educational purposes and should not replace medical advice. Always consult your healthcare provider for personalized guidance.