A women’s cervix is the lowest part of the uterus which extends into the vagina.  Cervical incompetence is a phenomenon when a woman’s cervix opens too early and could be a cause of preterm labor or second trimester miscarriage.  Approximately 1% of pregnancies are complicated by an incompetent cervix.  A woman may have an incompetent cervix due to a congenital (present at birth) abnormality with her cervix, tissue integrity problem due to a connective tissue disorder, trauma or damage from a cone biopsy, LEEP procedure or other cervical surgery, or other unidentified cause. 

Symptoms

Some individuals may have symptoms of preterm labor such as cramping, vaginal discharge, or leakage of fluid vaginally as a indication that the cervix is opening or dilating.  Many other women do not have any physical symptoms, but may have a history of preterm labor or second trimester miscarriages.  An ultrasound evaluation is available to evaluate cervical length and dilation during pregnancy. 

Treatment options

Treatment for cervical incompetence is often, a cervical cerclage, was first described in 1950 by Dr. Lash.  This is a surgical procedure in which a stitch is placed around the cervix to hold it closed.  This is intended to help prevent the cervix from opening prematurely and causing preterm labor or miscarriage. Some women with a known history of cervical incompetence will have a prophylactic (before the cervix begins to open) cerclage placed early in pregnancy.  Others have a cerclage placed later in pregnancy because the cervix is already opening and this is considered an emergency cerclage. 

A cerclage can be placed vaginally or abdominally both having between an 80-90% success rate when true cervical incompetence exists.  Unfortunately cervical incompetence can be very difficult to diagnose. In some cases cervical incompetence is assumed to be the problem for a couple that has recurrent preterm labor or second trimester miscarriages when in fact it is just one of many possible explanations for these unfortunate pregnancy complications. 

Before it is decided that cervical incompetence is present or a cerclage is necessary, a consultation will be beneficial to discuss the procedure in detail, the risks and benefits, as well review your medical history.

 

 

Resources

Lash,AF, Lash, SR. Habitual abortion; the incompetent internal os of the cervix. Am J Obstet Gynecol, 1950; 59:68.

Callen, Ultrasonography in Obstetrics and Gynecology. Saunders. 4th  Edition, 577-596.

Uldbjerg, N, Forman, A, Peterson, LK et al . Biochemical changes of the uterus and cervix during pregnancy. In: Reece, EA , Hobbins, J, Mahoney, MJ et al eds. Medicine of the fetus and of the mother. Philadelphia: JB Lippincott; 1992:849.

Parulekar, SG, kiwi, R. Dynamic incompetent cervix uteri: sonographic observations. J. Ultrasound Med. (1988) 7:481

Guzman, ER, Forster, JK Vintzileos, AM Ananth CV, Walters, C, Gipson, K Pregnacy outcomes in woman treated with elective versus ultrasound-indicated cervical cerclage. Ultras. Obst. Gynecol, 1998 Nov, 12 (5): 301-3.