If you have a history of an incompetent cervix in a previous pregnancy or have been told you have other risk factors for the condition, you probably have questions and concerns about the complication, also known as cervical insufficiency.
An incompetent cervix can increase the chances of premature birth or pregnancy loss if left untreated. While the thought alone is enough to make your stomach churn, there's reason to be optimistic. Most women with cervical insufficiency can go on to have a healthy, full-term pregnancy when the condition is caught and managed early.
What is an incompetent cervix?
An incompetent cervix, or cervical insufficiency, occurs when the cervix shortens, thins and begins dilating too early under the pressure of the growing uterus and fetus.[1]
Occurring in roughly 1 or 2 out of every 100 pregnancies, usually in the middle of the second or early in the third trimester, it can increase the chance for premature birth or pregnancy loss.
In a healthy, uncomplicated pregnancy, the cervix (the narrow end of the uterus that connects to the vagina) remains long, firm and closed until late in the third trimester when the body starts preparing to give birth.
In cases of cervical insufficiency, the cervix starts to get shorter and softer earlier, and sometimes even opens early. This can cause a woman to give birth too early.
OB/GYNs and maternal fetal medicine specialists often look at incompetent cervix on a spectrum rather than as a black-and-white condition. Women with a history of cervical insufficiency, those with certain risk factors, or those who are experiencing early cervical shortening without symptoms may be treated preemptively for cervical insufficiency to protect the pregnancy and reduce the chance of preterm birth.
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In other cases, the condition may not be diagnosed until later, when the cervix has already begun to open.
What are the symptoms of an incompetent cervix?
An incompetent cervix doesn't always come with symptoms. But some women do notice early signs, often between 14 and 20 weeks of pregnancy. These may include:
Dull pelvic pressure
Lower back pain
Mild abdominal cramping
Light spotting or bleeding
Change in vaginal discharge
If a woman has a history of incompetent cervix or presents with other risk factors, she may be monitored closely with regular transvaginal ultrasounds. These imaging tests can help spot possible signs of cervical shortening sooner, enabling her health care team to take steps to increase the chance that the pregnancy will be carried to term.
Causes of an incompetent cervix
Experts don't fully understand what causes cervical insufficiency. That said, certain factors can make a woman more prone to developing the complication.[2] These include:
Cervical changes caused by an infection or inflammation
Congenital disorders of the woman’s connective tissue, including Ehlers-Danlos syndrome, or Marfan syndrome
Congenital birth defects in the mother causing a misshapen uterus
Cervical trauma or injury from a previous birth
Trauma or injury from cervical procedures including LEEP (loop electrosurgical excision procedure) or cone biopsies for abnormal tissue in the cervical cells
In rare cases, procedures involving forced dilation of the cervix, like a dilation and curettage (D&C), although this procedure does not cause incompetent cervix for most women
A woman who has experienced cervical insufficiency in a previous pregnancy is at higher risk of being affected in future pregnancies. Pregnancies with multiples are more prone to cervical insufficiency too, since the added weight of multiple babies can potentially put more pressure on the cervix.
Complications associated with an incompetent cervix
Incompetent cervix can potentially lead to:
Vaginal bleeding
Early water breaking
Premature birth
Pregnancy loss
These complications can be scary to think about, and indeed, cervical insufficiency is a serious complication. But in many cases the condition can be managed to increase a woman's chances for carrying her pregnancy to term. And if you have a history if incompetent cervix or present with other known risk factors, your provider will closely monitor your cervix to check for potential signs of shortening sooner, when it can be treated more effectively.
How is an incompetent cervix treated?
Cervical insufficiency is often treatable, especially when it's caught early. If you're at risk of the condition or have a history of being diagnosed with an incompetent cervix, it's important to be monitored by a maternal fetal medicine specialist.
You'll undergo regular ultrasounds to check the length of your cervix and see whether it's starting to change sooner than it should.
Together, you and your provider can decide on the right treatment option based on your health history and whether your cervix is currently showing signs of shortening too early. These typically include:
Cerclage. Typically done somewhere between 12 to 24 weeks of pregnancy, cerclage involves placing drawstring-like sutures around the cervix to keep it closed. The procedure is usually done transvaginally but occasionally transabdominally. When it's time for the baby to be born (or shortly before, by around 37 weeks), the cerclage will be snipped out (although sometimes the stitches are left in place and the baby delivered by cesarean section). Women with cerclage may need to restrict certain activities, like standing for long periods or lifting heavy objects. Your practitioner may recommend pelvic rest (meaning no sex) as well, but that can vary based on your individual symptoms and health history.
Vaginal progesterone. The hormone progesterone helps prevent the womb from having contractions. Vaginal progesterone, which is a gel or cream inserted into the vagina every night, is typically recommended for women with a short cervix who haven't had a history of previous pregnancy loss from cervical insufficiency.
Pessary. This device, which is fitted into the vagina to hold the uterus in place, may help take some pressure off the cervix. The evidence is mixed on whether it's effective for treating an incompetent cervix, so it's less commonly used.
Facing an increased chance of an incompetent cervix can be unsettling, especially if you have a history of cervical insufficiency. While there are no sure answers, knowing that you're at risk may be the best form of protection, since regular monitoring by a specialist is effective at catching the problem — and treating it — early. And when that happens, there's a very good chance that you'll go on to have a healthy, full-term pregnancy.
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