Pregnancies are supposed to be a life event that brings forth spurts of unadulterated joy and absolute love for your precious one. Perhaps because of this, it also bore a wealth of guilt and sadness that can only be deemed heartbreaking. For those who have dreamt of having a family of their own, a body that is ill-equipped to conceive a baby to full term can easily be soul-crushing, more so when unforeseen complications arise during a seemingly smooth pregnancy.
Unfortunately, this will be a common experience among individuals diagnosed with an incompetent cervix. Discover all you need to know about this fertility complication and treatments to increase the probability of having a full-term pregnancy.
Otherwise known as cervical insufficiency, an incompetent cervix refers to when the cervix opens during the second trimester of the pregnancy. During a normal pregnancy, the cervix begins to open (through dilation and effacement) during the final days of pregnancy to prepare for the baby’s delivery. However, those with an incompetent cervix will experience the dilation of the cervix too early during the pregnancy, usually without pain or contractions. Unfortunately, this almost always results in a miscarriage or premature birth. Unless an incompetent cervix treatment is employed, the risk of repeated pregnancy loss remains high.
Cervical Insufficiency: The Development
Cervical incompetence may be congenital or acquired, meaning that it could be an inherited condition or one that you developed later on in life.
There are several congenital causes, one of which is a defect in the embryological development of the Mullerian ducts, primordium ducts that develop into female internal organs like the uterus, uterus ducts, and cervix. Individuals diagnosed with Ehlers-Danlos syndrome or Marfan syndrome will experience collagen deficiency. Since the physiological properties of the cervix depend on the interplay between collagen and glycosaminoglycan molecules, a collagen deficiency may lead to an incompetent cervix.
Similarly, there are multiple acquired causes of cervical incompetence, but the most common one is cervical trauma. This can take in the form of cervical lacerations during childbirth, cervical conization (a surgical procedure to treat or diagnose cervical dysplasia), loop electrosurgical excision procedure (surgical approach to remove abnormal tissue from the cervix), or forced cervical dilatation during a uterine evacuation. Changes to the cervix physiological properties can also be attributed to an infection or inflammation, which may have prompted an early activation of the final pathway of childbirth.
The problem with cervical incompetence lies in its symptoms or the lack thereof. The symptoms associated with this condition often overlap those affiliated with pregnancies, such as an increase in vaginal discharge or pelvic pressure. As such, many would dismiss these symptoms as non-atypical, and once the diagnosis rolls in, it would often be too late. That said, it is worth noting the list of signs that may point to cervical incompetence. Be on the lookout for:
- A sensation of pelvic pressure
- A new backache
- Mild abdominal cramps
- A change in vaginal discharge
- Light vaginal bleeding
Incompetent cervix is not routinely checked for during pregnancy. You may, however, request for a diagnostic investigation during the second trimester, more so if you display potential causes of an incompetent cervix. Your physician can make a diagnosis through a pelvic exam or by transvaginal ultrasound. Unfortunately, there are no pre-pregnancy tests to reliably diagnose an incompetent cervix. However, you may want to consider an MRI or an ultrasound to detect uterine abnormalities, which may lead to the said complication.
Incompetent Cervix Treatments
Unfortunately, there are no precautionary measures to prevent an incompetent cervix. However, there are a few treatment options you may want to consider. Treatment options may include:
1. Progesterone Supplementation
If you have a history of premature birth, you may be given be weekly shots of progesterone shots to reduce the risk of a recurrence during the first twelve weeks (the window wherein miscarriages often occur). Aside from shots, you can also opt for a vaginal progesterone cream or suppository. Most doctors would recommend starting at 16 weeks, continuing until 36 weeks.
If you have managed to catch signs of an incompetent cervix during your pregnancy and your baby display a high chance of survival (usually after 22 weeks), your doctor may recommend antenatal steroids. When paired with other medications, such as tocolytics, steroids can prevent preterm labour as well as improve the development of your baby’s respiratory system, specifically their lungs.
3. Cervical and Transabdominal Cerclages
If you display risk factors for cervical insufficiency, cervical cerclage is a viable option to reduce your chances of preterm delivery. Cervical cerclage is a procedure that involves stitching your cervix with a band of strong thread to reinforce it and hold it close. To make sure that the stitch does not unravel, you are advised to avoid strenuous and sexual activities for the rest of your pregnancy. This outpatient procedure is typically done between weeks 14-16 of pregnancy, and the sutures will be removed between 36-38 weeks to prevent any labour complications. Once the sutures are removed, you can relax and wait for the contractions to kick in.
This procedure is extremely popular among those at risk of premature birth – it boasts an overall success rate of 80%. However, do note that not all women are eligible candidates for cervical cerclages. If you display the following symptoms, you may want to consult your doctor for other alternatives:
- Increased irritation of the cervix
- The cervix has dilated by 4cm
- Membranes have ruptured
- Multiple pregnancy
A possible alternative includes transabdominal cerclage, a procedure done either between pregnancies or during the late first trimester. Unlike cervical cerclage, which involves inserting the cerclage through the vagina, transabdominal cerclage requires an abdominal operation. This major operation requires a large abdominal incision and an overnight stay. Since the transabdominal cerclage is permanent, you will need to deliver your baby via c-section.
Since a cerclage treatment is a relatively invasive procedure, be sure to talk to your doctor about the risks and benefits before considering it as a viable option.
Engage Our Gynaecological Team for Help
Many women feel an overwhelming amount of guilt when they experience a late miscarriage or premature birth caused by cervical incompetence. The notion of pregnancy and family building may feel doubly as hard when you have gone through something that traumatic. If taking the next step is too difficult, let us be there for you.
As a reliable fertility clinic in Singapore, The O&G Specialist Clinic is committed to bringing you a step closer to fulfilling your dreams of parenthood. Our team of gynaecologists and specialists is equipped with a wealth of experience in assisting infertile couples in finding the ideal fertility treatment that aligns with their specific needs. Our holistic approach to gynecologic care also means that we will support you in all areas of your health – reproductive, physical, and emotional. Take
We care for your well-being and fertility. Book a virtual consultation and head down to our fertility clinic in Singapore today.
Thakur, M., & Mahajan, K. (2021). Cervical Incompetence. StatPearls [Internet].
Sabr, Y., & Yousef, S. W. (2018). Transabdominal Cerclage: Different Indications, Optimal Outcome. Two Case Reports. Int J Womens Health Wellness, 4(067), 2474-1353.