Every day, our nurses and attorneys receive calls from expectant mothers with concerns about symptoms they’re experiencing during their pregnancy. They’re curious if their symptoms are normal, and they wonder what their next steps should be. Patients should always visit a medical professional with concerns like these and receive appropriate care for maternal-fetal conditions and illnesses that can arise during pregnancy. We kickstarted the Pregnancy Spotlight Series, a monthly column that highlights specific pregnancy health concerns, to help educate and empower patients for these medical visits. Today, we’re focusing on Insufficient (Weakened) Cervix (also known as incompetent cervix or cervical insufficiency).
Insufficient Cervix (also called weakened cervix, incompetent cervix, or cervical insufficiency) is a condition that occurs when weakened cervical tissues result in or contribute to premature delivery or miscarriage. For more information on Cervical Insufficiency and Preterm Delivery, visit our main page on the topic.
Who is at risk of developing cervical insufficiency?
Insufficient cervix occurs in in 1 to 2 out of 100 pregnancies but results in 20 to 25% of second trimester pregnancy losses. The risk is increased for women who have experienced:
- A difficult previous birth which caused damage to the cervix
- A malformed uterus or cervix as a result of a birth defect
- Exposure to Diethylstilbestrol (DES)
- Previous trauma to the cervix (ex. Dilation and curettage)
- Prior cervical surgery
- Prior preterm labor or delivery
- Prior diagnosis of incompetent cervix or cervical insufficiency
How is cervical insufficiency diagnosed?
Women who have risk factors for insufficient or weakened cervix can be checked for the condition via an ultrasound which measures the length of the cervix or the cervical opening. In addition to ultrasound, doctors may also choose to do a pelvic exam, which can show them whether the cervix is shortening or opening or if the amniotic sac has begun to protrude through the opening of the cervix. Finally, your doctor may take a sample of the amniotic fluid to diagnose or rule out an infection of the fluid and amniotic sac.
If your doctor believes that, based on your medical history, you may be at risk for insufficient cervix, he or she will likely check you regularly with a transvaginal ultrasound beginning at 16-20 weeks. Patients who think they may be at risk for insufficient cervix are encouraged to discuss concerns with their doctors.
Do patients with cervical insufficiency experience symptoms when the cervix begins to open?
Some women may not experience signs or symptoms as their cervix begins to open if it is weakened. However, others will experience the following and should mention these symptoms to their doctor immediately:
- A feeling of pelvic pressure
- Light vaginal bleeding
- A change in vaginal discharge
- Mild discomfort or spotting over several days or weeks beginning between 14 and 20 weeks
- Mild abdominal cramps
Can cervical insufficiency be treated?
Treatments for insufficient cervix include preventive medication during pregnancy (progesterone shots and suppositories), frequent ultrasounds, and a procedure called cervical cerclage, in which a stitch is placed on the cervix . The sutures are commonly placed around 14-16 weeks of pregnancy but may be placed any time up to 24 weeks. It is removed around 36-38 weeks. Progesterone and cerclage have proven to be very effective in preventing preterm birth in the right circumstances. Though unlikely, cervical cerclages can pose risks for the patient or the baby, including cervical infection, ruptured membranes, premature contractions and others. Therefore, the doctor must inform you of the risks and benefits be discussed.. Always ask your doctor if you have a concern and discuss possible treatments with him or her first.
- American Pregnancy Association: insufficient Cervix (Weakened Cervix)
- American Pregnancy Association: Cervical Cerclage
- March of Dimes: Cervical Insufficiency and Short Cervix
- Mayo Clinic: Insufficient Cervix
The information presented above is intended only to be a general educational resource. It is not intended to be (and should not be interpreted as) medical advice. If you have questions about the topic, please consult with a medical professional.