Cervical Insufficiency

Cervical insufficiency, also known as cervical incompetence, is a medical condition that occurs when the cervix is unable to maintain its shape and consistency during pregnancy, leading to premature dilation and potentially resulting in preterm birth.

Causes and Risk Factors

The exact cause of cervical insufficiency is often unknown, but several factors can increase the risk of developing this condition. These include:

• Prior cervical or uterine surgery, such as a cone biopsy or LEEP procedure
• History of preterm birth or second-trimester miscarriage
• Cervical trauma, such as from a previous difficult delivery or abortion
• Uterine anomalies, such as a unicornuate uterus
• Exposure to diethylstilbestrol (DES) in utero
• Genetic disorders that affect collagen production, such as Ehlers-Danlos syndrome

Symptoms and Diagnosis

Symptoms of cervical insufficiency may include:

• Pelvic pressure or discomfort
• Back pain or abdominal cramping
• Vaginal bleeding or spotting
• Increased vaginal discharge

Diagnosis of cervical insufficiency is typically made through a combination of:

• Medical history and physical examination
• Ultrasound evaluation to assess cervical length and funneling
• Pelvic exam to evaluate cervical dilation and effacement

Treatment and Management

Treatment for cervical insufficiency depends on the severity of the condition and the gestational age of the pregnancy. Options may include:

• Cervical cerclage, a surgical procedure to close the cervix with sutures or tape
• Progesterone supplementation to support cervical health
• Bed rest and pelvic rest to reduce stress on the cervix
• Close monitoring of fetal growth and well-being through regular ultrasounds and non-stress tests

Complications and Prevention

Untreated cervical insufficiency can lead to preterm birth, which increases the risk of complications for both the mother and baby. Complications may include:

• Low birth weight and respiratory distress syndrome in the newborn
• Infection and sepsis in the mother
• Placental abruption and postpartum hemorrhage

To prevent cervical insufficiency, women with a history of preterm birth or cervical surgery should discuss their individual risk factors with their healthcare provider. Regular prenatal care and close monitoring can help identify potential issues early on.

Frequently Asked Questions (FAQs)

What is cervical insufficiency?
A condition where the cervix begins to dilate too early in pregnancy.

What are the symptoms of cervical insufficiency?
Painful contractions, vaginal bleeding, and cervical dilation before 37 weeks.

What causes cervical insufficiency?
Weakness in the cervical tissue, often due to previous surgery or trauma.

How is cervical insufficiency diagnosed?
Through pelvic exam, ultrasound, and medical history review.

Can cervical insufficiency be treated?
Yes, with cervical cerclage, bed rest, and progesterone therapy.

What is a cervical cerclage?
A surgical procedure to close the cervix with stitches.

How effective is cervical cerclage in preventing preterm birth?
It can reduce the risk of preterm birth by 30-50%.

Are there any risks associated with cervical cerclage?
Yes, including infection, bleeding, and cervical scarring.

Can women with cervical insufficiency have a vaginal delivery?
Possibly, but often require a cesarean section to prevent complications.

How can cervical insufficiency be prevented?
By avoiding excessive physical activity and managing underlying medical conditions.