The supreme power of nature is manifested in the core of human existence, in the way a woman’s body is designed to nurture a new life and bring it to the world. Each reproductive organ has its own function, whether it is the ovaries, the fallopian tubes, the uterus, the cervix or the vagina and all of them work in perfect co-ordination to bring about the miracle called birth. Any problem with one or more of these organs can lead to a number of fertility and birth related complications.
The cervix is the lower part of the uterus which is connected to the vagina and normally, it remains closed till the end of the gestation period. As the pregnancy advances, the cervix gets ready for the delivery by softening its tissues and dilating. Speaking about cervical incompetence or cervical insufficiency, it is a condition in which the cervical tissue is weak and it opens up sooner than the end of pregnancy. The woman is unable to sustain a baby till full-term and as a result, a premature birth may take place.
There is no way to tell whether a woman suffers from cervical incompetence or not, till she actually gets pregnant and reaches a stage when cervix becomes weak to sustain the growing baby, generally during the second or third trimester. Being a condition hard to diagnose, it is harder to treat but this does not mean that the pregnancy will always be lost. The condition can be handled with the expertise of the doctor and a little alertness and precaution by the patient.
What are the symptoms of cervical incompetence?
Cervical incompetence is a rare condition, with 1-2% of pregnancies coming across the condition. It is usually manifested in the second trimester or early third trimester of the pregnancy, and numerous stillbirths during this phase are attributed to cervical incompetence. A woman needs to pay attention to the subtle symptoms that her body gives as these may be the only indication of an incompetent cervix till it gets too late. Here are some symptoms she may experience:
- Mild discomfort with/without minor spotting which starts between 14-20 weeks of the pregnancy
- Pelvic pressure, abdominal cramps and/or backache
- Change in vaginal discharge, as this may be a painless leakage of waters
As the cervix dilates painlessly, the membranes may bulge into the vagina, without the woman’s realizing that she is already in labor. The mildness of symptoms is something that makes the condition all the more dangerous for the mother and the baby.
What are the risk factors of cervical incompetence?
There may be varied reasons which increase the risk factor for cervical incompetence:
- A woman is most likely to be plagued by cervical incompetence because of an inherent congenital or genetic weakness. This may be caused by a structural defect in the uterus or exposure of the patient to a synthetic form of estrogen called DES (diethylstilbestrol) and surprisingly, this happens before her birth
- Cervical trauma in the form of an injury or a difficult previous delivery (during which the cervix may have been torn) is another high risk factor of cervical incompetence. Surgical procedures such as an abnormal PAP smear may also be a leading cause
- In some cases, a woman who undergoes Dilation and Curettage (D&C) for clearing the uterus after an abortion or miscarriage, or for diagnostic purposes ( for excessive bleeding or some other complication) may get afflicted by structural damage to the uterus and consequently, is put to a high risk of cervical incompetence
Diagnosis of Cervical Incompetence
Diagnosis of cervical incompetence does not form a part of the routine tests during pregnancy but a woman at high risk or those who have been through it in previous pregnancies can be evaluated for the same. This can be done with a pelvic examination or a transvaginal ultrasound test, which involves the measurement of length of the cervix. The normal length of cervix is 4 cm and those with the length less than 2.5 cm are regarded to be at risk of preterm labor.
In addition to these diagnostic tests, the woman as well as her doctor has to be on their toes all through the pregnancy and every little symptom should be taken seriously as it can make the difference between life and death. For those with the first pregnancies, it is all the more important to be aware of the symptoms and read them in time.
Managing cervical incompetence
Cervical incompetence is a risky condition that puts a woman at the major peril of losing her pregnancy by going into premature labor. However, it is nothing that cannot be managed, provided that it is detected in time and requisite action is taken. A life-saving procedure called cervical cerclage is recommended in cases when the cervix seems to begin to get dilated or become shorter that a certain length, or those who have been through it before or at high risk.
Cervical cerclage is a surgical procedure which involves stitching of the cervix with strong sutures so that it gets secure enough to carry the pregnancy till a safe period. Typically, the procedure is done before 14 weeks of pregnancy and the sutures are removed in the last month or at the time of delivery, depending upon the individual conditions. It is not necessary that the woman will spontaneously go into labor once the sutures are removed and she may actually carry the pregnancy to full term after the sutures are removed.
At the same time, cervical cerclage is not suitable for every woman; those with ruptured membranes or irritation in the cervix are not recommended the same. Similarly, women carrying multiple pregnancies are not eligible for cerclage. The patient needs to be in touch with the doctor all through the pregnancy and the doctor too, need to monitor her regularly for any visible signs of complication and tell her when the right time for action is.
Healthy diet and lifestyle, good rest and abstinence from sexual activity are some other things that a woman with incompetent cervix should do to maximize her chances of a safe pregnancy. Trying to stay calm and stress-free is equally important and being taken care of by a good specialist goes a long way for the same.
Gaudium IVF is a renowned infertility clinic where patients are not only provided the latest in infertility treatment but are also helped to combat a variety of pregnancy-related complications. Visit Gaudium IVF for a free second opinion from Dr. Manika Khanna.