An incompetent cervix is one that is weak or which starts to open up before it is required to and can happen in the case of one in hundred pregnancies. Cervical incompetence or insufficiency can result in miscarriage or premature delivery, according to the American Pregnancy Association website.
An estimated one fourth of all miscarriages that occur in the second trimester of pregnancy, occur due to an incompetent or weak cervix, so this is a very significant cause of miscarriages.
How can a woman tell if she has an incompetent cervix?
An incompetent cervix is likely to occur most typically between the third and seventh months of a pregnancy and takes the form of a ‘Silent Cervical Dilation’ – here the cervix starts to dilate without any labor pains.
So while it may be difficult to predict or know about cervical insufficiency, there are certain risk factors that are known to increase chances of a woman having an incompetent cervix – if a woman has undergone cervical cautery or has had other surgery performed previously in the cervix area or if damage occurred to the cervix due to a difficult birth, or if trauma had occurred due to a prior D&C procedure, the muscles there may become injured and weak.
Sometimes an incompetent cervix occurs as a result of a malformation or defect that exists from birth. Exposure to DES (Diethylstilbestrol) can also exacerbate the problem.
So if any of these risk factors are known to exist, a woman should be cautious and mention them to her obstetrician and gynecologist when she goes for an antenatal check up. The doctor will then decide to investigate by way of an ultrasound or a pelvic exam to check the health of the cervix.
A trans-vaginal ultrasound performed at 16 to 18 weeks gestation may be able to indicate the length of the cervix and if there is any sign of premature effacement.
Is it possible to treat an incompetent cervix after getting pregnant?
While cases of cervical insufficiency are difficult to detect until it is too late, in some cases where it is detected, treatment can be initiated.
In some cases such as if there is a rupture of certain membranes, or if the cervix has dilated more than 4 centimeters, or if the area is inflamed or irritated, it is not possible to treat an incompetent cervix.
However otherwise it may be possible to perform a surgery about the 12th week of pregnancy to resolve the problem. In this surgery, Cerclage (closing of the cervix by stitching) is carried out through or about the cervix so that the cervix doesn’t open up prematurely leading to a miscarriage.
After the Cerclage, women are generally advised to be on bed rest for a continued period to prevent any pressure being put on the cervix. This way the chances of carrying a pregnancy to term are greatly enhanced.
When the due date approaches, the cerclage may be removed to allow for a natural vaginal delivery. However if a cesarean section is to be performed (it could be a medical requirement in some cases) then many doctors may choose not to remove the stitches and may choose to leave them in place.