Cervical Incompetence - Symptoms, causes and treatment

2023 Author: Autumn Gilbert | [email protected]. Last modified: 2023-11-27 07:39

Cervical incompetence or cervical insufficiency is a condition when the cervix (cervix) opens too early in pregnancy. This condition can cause sufferers to experience premature labor or miscarriage, especially in the second trimester of pregnancy

Before pregnancy, the cervix or cervix is normally solid, rigid, and closed. As pregnancy progresses and as you prepare for birth, the cervix will gradually soften and open. However, in pregnant women who experience cervical incompetence, the cervix softens or opens too early.

Causes and Risk Factors for Cervical Incompetence

It is not known exactly what causes cervical incompetence. However, the risk of cervical incompetence is higher in pregnant women with the following conditions:

• Have experienced sudden premature labor
• Have you ever had a biopsy or surgery on the cervix
• Have had a miscarriage in the second trimester
• Have you ever experienced an injury to the cervix due to childbirth or a curettage
• Have you ever had the synthetic hormone diethylstilbestrol (DES) before getting pregnant
• Has an abnormality in the uterus or cervix
• Has a birth disorder that affects the body's connective tissue, such as Ehlers-Danlos syndrome

Symptoms of Cervical Incompetence

Cervical incompetence does not always cause symptoms, especially during early pregnancy. Generally, new symptoms appear at 14–20 weeks of gestation.

Symptoms of cervical incompetence, including:

• Feeling pressure on the pelvis
• Sudden back pain
• Stomach cramps like during menstruation
• Vaginal discharge that is pink or brown in color
• Vaginal discharge is more or more liquid
• Mild bleeding from the vagina (spotting)

When to see a doctor

Immediately check with a doctor if you experience the above symptoms. Cervical incompetence must be treated quickly so that pregnant women do not miscarry.

Do regular pregnancy check-ups to the obstetrician, so that the condition of the mother and fetus is monitored. Follow the obstetrical examination schedule according to the following schedule:

• 1 month, from the 4th week to the 28th week
• 2 weeks, from 28th week to 36th week
• 1 week, from 36th week to 40th week

Diagnosis of Cervical Incompetence

The doctor will ask about the symptoms experienced and the patient's medical history. The doctor will also evaluate whether the patient has any factors that put him at risk for cervical incompetence.

To confirm the diagnosis, the doctor will perform the following examinations:

• transvaginal ultrasound, to measure the depth of the cervix and check for any membranes protruding from the cervix
• Examination in the pelvis, to feel whether the amniotic sac protrudes into the cervix or vagina
• Examination of amniotic fluid samples (amniocentesis), to rule out infection in the amniotic sac and amniotic fluid

Cervical Incompetence Treatment

Treatment of cervical incompetence can not only be done in patients who have already experienced it, but can also be performed on patients who have not experienced cervical incompetence but are at high risk of experiencing it.

Treatment of cervical incompetence

If the examination finds that the cervix has opened, the treatment can be done by strengthening the cervix with the help of sutures or supports. Here is the explanation:

• Cervical cerclageCervical suturing can only be done if the gestational age is 24 weeks or less. This method is usually performed if the patient has a history of preterm delivery and the results of ultrasound examination in pregnancy show cervical incompetence. The cervical stitches will be opened before delivery.

• Pessary installationPessary is a tool that serves to support the uterus to keep it in position. Pessaries can also reduce pressure on the cervix.

Treatment of cervical incompetence risk factors

Treatment that can be done to prevent miscarriage or premature birth in patients at risk of cervical incompetence, among others:

• Progesterone supplementation injectableProgesterone supplements (hydroxyprogesterone caproate) are usually given to patients who have a history of preterm delivery. Injections of this supplement are given during the second and third trimesters.

• Monitoring with ultrasoundMonitoring with ultrasound is done in patients who have given birth prematurely or have other factors that can increase the risk of cervical incompetence. Monitoring is carried out every 2 weeks, from 16 weeks to 24 weeks of gestation.

Cervical Incompetence Complications

As explained above, cervical incompetence can lead to premature labor and miscarriage. Although rare, stitches to treat cervical incompetence can also cause complications, such as:

• Bleeding
• Tear of uterus (uterine rupture)
• Tear of cervix
• Infection

Prevention of Cervical Incompetence

Cervical incompetence cannot be prevented. However, ultrasound or MRI scans can be performed before pregnancy to detect abnormalities in the uterus, which are a risk factor for cervical incompetence.

In pregnant women, the risk of cervical incompetence can be reduced by taking the following steps:

• Conducting regular pregnancy check-ups, so doctors can know the progress of the condition of pregnant women and fetuses
• Consuming he althy foods with balanced nutrition and ensuring the adequacy of essential nutrients for pregnant women, such as folic acid and iron
• Avoid exposure to harmful chemicals, such as cigarettes and alcohol, and consult a doctor before taking drugs
• Controlling weight gain during pregnancy