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Cervical Incompetence
What is the cervix and what is its function?
The cervix is that particular part of the uterus that represents the only natural opening of the womb to the vagina. The role of the cervix during pregnancy is to stay closed and long so that it can keep the contents of the uterus (fetus, amniotic fluid, placenta, membranes etc.) safe and sound for nine months. The cervix not only functions mechanically to resist the passage of the uterine contents prior to term, but also serves as a sophisticated biologic barrier between the non-sterile vaginal environment and the sterile intra-uterine environment.
How is cervical incompetence diagnosed?
Failure of the cervix to perform its normal functions is called cervical incompetence and often results in pre-term delivery and sometimes even in loss of the pregnancy in the second trimester. The likelihood of this condition is probably less than 1% among pregnant women and the cause is not known. Previous surgical procedures and trauma (such as cervical cone biopsy for pre-cancerous lesions or cervical tears during traumatic birth or DES exposure) may pre-dispose a woman to cervical incompetence, but the exact relationship is not completely clear.
Since there are no clear diagnostic tools, the presence of this condition is determined using either:
1-Previous obstetrical history, or
2-Estimation of cervical length done with digital exam and/or ultrasound in the current pregnancy.
- Obstetrical History: If a woman has a history of recurrent second trimester loss including shortened cervix without painful contractions, she is suspected of having cervical incompetence.
- A cervix in the second or third trimester that has shortened significantly (less than 2.5 cm) is associated with an increased risk of preterm delivery and there may be a suspicion of cervical incompetence.
How is cervical incompetence managed?
There are two interventions used either alone or in combination to manage cervical incompetence:
- Bed-Rest: To reduce the pressure exerted on the cervix and prevent it from further shortening and dilation.
- Cervical Suture-Cerclage: This is a surgical procedure designed to put a purse-string stitch around the cervix as a mechanical support and help prevent shortening and dilation. Typically the cerclage is removed at 35-37 weeks’ gestation to permit vaginal delivery. In most centers in the USA cervical cerclage will not be inserted after 23 weeks gestation.
What are the complications of cerclage?
- Bleeding and Infection
- Procedure related pregnancy loss
- Injury to adjacent tissue (urinary bladder, vagina, cervical tear)
- Premature labor and delivery
The frequency of these complications is directly related to cervical condition and the gestational at the time of surgery.
Cervical incompetence is a medical condition which may contribute to preterm birth. The perinatologists at SFPA will work with your doctor to diagnose and manage your pregnancy to obtain the best possible outcome.
If you are at risk for cervical incompetence your doctor will request a consult with the perinatologists at SFPA who are experts at cervical assessment and placement of cerclage.
