The chance of miscarriage decreases greatly after you’ve have reached 14 weeks pregnant. (A majority of all miscarriages occur within the first 13 weeks of pregnancy.) Unfortunately, some women can experience a second trimester miscarriage as a result of incompetent or weakened cervix. Approximately 25 percent of miscarriages and pregnancy losses are a result of this devastating complication.
In a healthy pregnancy, your cervix will remain firm and shut until the final weeks of your pregnancy. Then, when your body is preparing for labor and delivery, the cervix will begin to efface (soften) and dilate (open up). When you are fully dilated (10 centimeters), your baby will be delivered.
In a woman with cervical insufficiency, also called incompetent cervix, her cervix is weaker and softer than it should be. As her pregnancy continues and her uterus becomes larger and heavier, her weakened cervix may begin to open up (dilate) without her feeling any contractions. This can happen as early as the second trimester.
Cervical insufficiency can cause a handful of complications such as miscarriage, a complication called preterm premature rupture of the membranes (in which your bag of water breaks prior to the onset of true labor), early preterm delivery (a baby born 32 weeks pregnant), and premature labor (before 37 weeks pregnant).
Incompetent Cervix Diagnosis
top Healthcare providers don’t routinely check for cervical insufficiency, and medical researchers haven’t determined a reliable way to screen for this pregnancy complication.
Fact: Cervical insufficiency cannot be diagnosed before pregnancy. Checking cervical function with the use of balloons or dilators has not been proven to work. Doctors can use ultrasounds, MRIs, and a special X-ray test called a hysterosalpingogram (which looks inside your uterus and fallopian tubes) to detect a uterine abnormality, which puts you at risk for a weakened cervix, but these methods are not diagnostic.
Diagnosing an incompetent cervix in a first pregnancy is difficult, because the symptoms are usually dismissed as normal pregnancy symptoms. Symptoms of an incompetent cervix may include the following: vaginal bleeding, bloating, menstrual cramping, pelvic pressure or discomfort (usually on one side of the abdomen), and increased vaginal discharge.
In many cases, women who are pregnant for the first-time won’t realize they have a weak cervix until after they experience a second trimester miscarriage. In some cases, the woman will not be diagnosed until she goes into early pre-term labor (or labor that occurs before 32 weeks). Once you’re diagnosed, your caregiver will be more prepared in future pregnancies.
top You may be at elevated risk for cervical insufficiency if you have an abnormally short cervix; if your mother took the drug diethylstilbestrol (DES) when she was pregnant with you; if you’ve had surgeries on your cervix; if you’ve experienced cervical trauma, as a result from past abortions or dilation and curettage (D&C) procedures.
In addition to the mentioned risk factors, your doctor may be on the lookout for signs of incompetent cervix if you have a history of second trimester deliveries, or you have repeatedly delivered early in previous pregnancies.
Cervical Cerclage
topIf you have been diagnosed with an incompetent cervix, your caregiver may recommend a procedure known as cervical cerclage, in which he or she will stitch your cervix shut. The procedure is performed as a preventative measure between 12 to 14 weeks pregnant. It is sometimes performed in emergency situations after your cervix is thinned.
In some circumstances, a cervical cerclage will not be effective. Cervical cerclage will not be performed if your cervix has dilated to 4 centimeters, if your water has broken, or your baby has died in utero.
Because cervical cerclage is a medical procedure, it presents some risks and side effects. These include a small risk of miscarriage and pregnancy loss, significant blood loss, cervical damage, and infection. Risks are rare, and many doctors consider this procedure necessary and life saving.
The stitches placed from the cervical cerclage procedure will be removed at delivery, or kept in place in the event you require a c-section.
When you have incompetent cervix, you are often placed on bed rest near the end of your pregnancy. You may also be asked to avoid from strenuous activity and engaging in sexual intercourse. In some situations, medications and drugs may be used to stop contractions.
If you have any questions or concerns regarding cervical insufficiency, be sure and discuss these with your healthcare provider.
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