Cervical insufficiency Manila PH

Cervical Insufficiency: Causes, Symptoms, Diagnosis, and Pregnancy Management

ByOBGYN

Cervical insufficiency, sometimes called an incompetent cervix, is a condition in which the cervix shortens, softens, or opens too early during pregnancy – often without pain or contractions. This can lead to pregnancy loss or preterm birth, usually in the second trimester.

While the diagnosis can feel overwhelming, early detection and proper care can significantly improve pregnancy outcomes.

What Is Cervical Insufficiency?

Cervical insufficiency occurs when the cervix is unable to stay closed and firm throughout pregnancy. Normally, the cervix remains tightly closed until late pregnancy or labor. In cervical insufficiency, the cervix begins to open prematurely under the weight of the growing pregnancy.

This condition is not caused by labor contractions and often develops silently.

How Common Is Cervical Insufficiency?

Cervical insufficiency affects about 1% of pregnancies, but it is more common among women with a history of second-trimester pregnancy loss or preterm birth.

Causes of Cervical Insufficiency

In many cases, the exact cause is unknown. However, several factors increase the risk:

1. Previous Cervical Trauma

  • Prior dilation and curettage (D&C)

  • Cervical surgery (such as LEEP or cone biopsy)

  • Injury during a previous childbirth

2. Congenital Cervical or Uterine Conditions

  • Naturally weak or short cervix

  • Uterine malformations

3. Connective Tissue Disorders

  • Conditions like Ehlers-Danlos syndrome

4. Multiple Pregnancies

  • Carrying twins or more increases pressure on the cervix

Signs and Symptoms

Cervical insufficiency often presents with few or no warning signs. When symptoms do occur, they may include:

  • Pelvic pressure

  • Lower back pain

  • Mild abdominal cramping

  • Increased vaginal discharge

  • Light spotting or bleeding

Because symptoms can be subtle, routine prenatal care is essential.

How Is Cervical Insufficiency Diagnosed?

Diagnosis is based on medical history and imaging.

1. Medical History

A history of painless cervical dilation, second-trimester losses, or preterm births raises suspicion.

2. Transvaginal Ultrasound

Measures cervical length. A cervix shorter than 25 mm before 24 weeks may indicate insufficiency.

3. Physical Examination

In some cases, early cervical dilation may be detected during a pelvic exam.

Treatment and Management Options

Management depends on gestational age, symptoms, and pregnancy history.

1. Cervical Cerclage

A surgical procedure in which stitches are placed around the cervix to keep it closed.

Types include:

  • Prophylactic cerclage (placed early in pregnancy)

  • Ultrasound-indicated cerclage

  • Emergency or rescue cerclage

Cerclage has been shown to reduce the risk of preterm birth in appropriate cases.

2. Progesterone Therapy

Progesterone may be given vaginally or via injection to help maintain pregnancy and reduce preterm birth risk.

3. Activity Modification

In some cases, reduced physical activity or pelvic rest may be advised.

4. Close Monitoring

Frequent ultrasounds and prenatal visits help track cervical length and pregnancy progress.

Pregnancy Outcomes With Cervical Insufficiency

With early diagnosis and proper management:

  • Many women carry pregnancies to term or near-term

  • Risk of pregnancy loss is significantly reduced

  • Healthy delivery outcomes are achievable

Can Cervical Insufficiency Be Prevented?

While it cannot always be prevented, risk reduction includes:

  • Early prenatal care

  • Cervical length screening for high-risk women

  • Timely intervention when changes are detected

When to Contact a Healthcare Provider

Seek immediate medical care if you experience:

  • Pelvic pressure or a feeling that something is “coming down”

  • Sudden increase in vaginal discharge

  • Vaginal bleeding

  • Lower back pain during pregnancy

Prompt evaluation can be life-saving for the pregnancy.

Emotional Impact and Support

Experiencing cervical insufficiency can be emotionally challenging, especially for women with previous pregnancy loss. Emotional support, counseling, and open communication with healthcare providers are important aspects of care.

Final Thoughts

Cervical insufficiency is a serious but manageable condition. With awareness, early diagnosis, and appropriate treatment, many women go on to have successful pregnancies. If you have risk factors or concerns, proactive care and regular prenatal visits are essential.

Knowledge empowers expectant mothers to advocate for their health and seek timely support.

Similar Posts