There are many factors, which can cause miscarriage. One of the reasons is linked to inability of the cervix to manage continuously increasing load during pregnancy and its opening that results in spontaneous abortion or preterm delivery and is called cervical incompetence. Cervical weakness symptoms may not be present up to 20th week of pregnancy. Cervical incompetence treatment includes protection of a pregnant woman from any negative factors, conservative options and, if needed, surgical intervention (such as cervical cerclage). Below we will discuss in detail possible causes and triggers of this condition, as well as cervical incompetence treatment options.
Cervical incompetence or insufficiency as it may also be known is a condition that occurs when cervical tissue causes or contributes to premature birth or the loss of a healthy pregnancy. The cervix before pregnancy is normally closed and rigid, as pregnancy progresses, the cervix gradually softens, decreases in length (effaces) and opens (dilates). On having cervical incompetence, the cervix begins to dilate too soon causing early birth. Diagnosis of an incompetent cervix can be difficult thereby making treatment difficult.
CERVICAL WEAKNESS SYMPTOMS
Symptoms of cervix incompetence may not be experienced as the cervix begins to open. Beginning from the 20th week It is best to be on the lookout for:
- Mild abdominal cramps
- Light vaginal bleeding
- Pelvic pressure sensations
- Change in vaginal discharge
CERVICAL INCOMPETENCE TREATMENT OPTIONS
Treatment for incompetent cervix includes:
- Progesterone supplementation: Doctors may suggest weekly shots of hydroxyprogesterone caproate (a form of hormone progesterone) where there is a history of premature childbirth. Presently, progesterone treatment has not been helpful for pregnancy with twins or more.
- Serial ultrasounds: This is carried out from the 15th week of pregnancy to observe the cervix. If the cervix begins to open or becomes shorter than a certain length, cervical cerclage might be recommended.
- Cervical cerclage: This is a procedure done to prevent premature birth; this involves the closed stitching of the cervix with strong sutures. The sutures are removed during the last month of pregnancy or during labour. This procedure is recommended to women who have a history of premature births and is done in the 14th week of pregnancy. Cervical cerclage is not recommended to women carrying twins or more.
CERVICAL INCOMPETENCE DIAGNOSIS
- Medical history: Cervical incompetence can only be detected during pregnancy; diagnosis can still be difficult especially if it’s the first pregnancy of the woman. The doctor can ask if second trimester pregnancy loss or cervical tear during a previous delivery has occurred before. Cervical incompetence can be diagnosed by the doctor if there is been:
A history of painless cervical dilation and second trimester deliveries.
A history of short labours and increasingly earlier deliveries in previous pregnancies.
Advanced cervical dilation and effacement before the 24th week of pregnancy without painful contractions, vaginal bleeding, ruptured membranes or infection.
- Transvaginal ultrasound: Transvaginal ultrasounds are used to evaluate the length of the cervix if the foetal membranes are not In the cervical canal or vagina. It helps to examine the foetal membranes.
- Pelvic exam: Here, the doctor examines the cervix to see if the amniotic sac has begun to protrude through the opening, that is, the prolapsed foetal membranes. It is said to be incompetent cervix if the foetal membranes are in the cervical canal or vagina.
- Lab tests: This is carried out if there are no symptoms of infection but the ultrasound shows signs of inflammation. Amniotic fluid samples are tested to diagnose or rule out an infection of the amniotic sac and fluid.