Sometimes the cervix opens and thins early, putting a pregnancy at risk. Learn more about this hard-to-diagnose condition.
An incompetent cervix happens when weak cervical tissue causes or plays a part in a premature birth or the loss of a healthy pregnancy. An incompetent cervix also is called cervical insufficiency.
The cervix is the lower part of the uterus that opens to the vagina. Before pregnancy, it's usually closed and firm. As pregnancy goes on and you get ready to give birth, the cervix slowly changes. It softens, gets shorter and opens. If you have an incompetent cervix, it might begin to open too soon causing you to give birth too early.
An incompetent cervix can be a hard problem to diagnose and treat. If your cervix begins to open early, or if you've had cervical insufficiency in the past, you might benefit from treatment. This might include having a procedure done to close the cervix with strong sutures, called a cervical cerclage. You also may take medicine to help the incompetent cervix and have ultrasound exams to check how things are going.
With an incompetent cervix, there may be no signs or symptoms during early pregnancy. Some women have mild discomfort or spotting before the diagnosis. Often, this occurs before 24 weeks of pregnancy.
Be on the lookout for:
Many women don't have a known risk factor. Risk factors for an incompetent cervix include:
An incompetent cervix may be risky for your pregnancy. Possible complications include:
You can't prevent an incompetent cervix. But there's a lot you can do to have a healthy, full-term pregnancy. For example:
If you've had an incompetent cervix during one pregnancy, you're at risk of premature birth or pregnancy loss in later pregnancies. If you're considering getting pregnant again, talk with your doctor to understand the risks and what you can do to promote a healthy pregnancy.
An incompetent cervix can be found only during pregnancy. It can be a difficult diagnosis to make, especially during a first pregnancy.
Your doctor or other member of your care team may ask about your symptoms and medical history. Be sure to tell your care team if you've had a pregnancy loss in the second trimester of a past pregnancy or if you have a history of preterm delivery. Also tell your care team about any procedures you've had on your cervix.
Your doctor might diagnose an incompetent cervix if you have:
Diagnosis of an incompetent cervix during the second trimester also may include:
There are no reliable tests that can be done before pregnancy to predict if you'll have an incompetent cervix. But certain tests done before pregnancy, such as an ultrasound or MRI, could help find congenital problems with the uterus that might cause an incompetent cervix.
During a transvaginal ultrasound, you lie on an exam table while a doctor or a medical technician puts a wandlike device, known as a transducer, into the vagina. Sound waves from the transducer create images of the uterus, ovaries and fallopian tubes.
Treatment options or ways to manage an incompetent cervix include:
Cervical cerclage. During this procedure, the cervix is stitched tightly closed. The stitches are taken out during the last month of pregnancy or just before delivery. You may need a cervical cerclage if you are less than 24 weeks pregnant, you have a history of early births and an ultrasound shows that your cervix is starting to open.
Sometimes, cervical cerclage is done as a preventive measure before the cervix starts to open. This is known as a prophylactic cervical cerclage. You might have this type of cervical cerclage if you've had an incompetent cervix with past pregnancies. This procedure often is done before 14 weeks of pregnancy.
Cervical cerclage isn't the right choice for everyone at risk of premature birth. For instance, the procedure isn't recommended if you're pregnant with twins or more. Be sure to talk to your doctor about the risks and benefits cervical cerclage may have for you.
In a cervical cerclage, strong stiches, called sutures, are used to close the cervix during pregnancy to help prevent premature birth. Often, the stitches are removed during the last month of pregnancy.
If you have an incompetent cervix, your doctor might suggest limiting sexual activity or avoiding certain other physical activities. This advice will depend on your individual situation.
It may be difficult to learn that you have an incompetent cervix. It may make you feel anxious about your pregnancy and afraid to think about the future. Ask your care team for suggestions on safe ways to relax.
Having a premature birth might make you feel that you did something to cause it. Or that you could have done more to stop it from happening. If you're struggling with these feelings, talk to your partner and loved ones, as well as your doctor. Try to focus your energy on caring for and getting to know your baby.
Tell your doctor about any risk factors you may have for an incompetent cervix. Also tell your doctor if you have any symptoms during your second trimester that might mean you have an incompetent cervix. Depending on the situation, you might need immediate medical care.
Here's some information to help you get ready for your appointment, as well as what to expect from your health care provider.
If there's time before your appointment, you might want to:
Basic questions to ask your doctor about problems with the cervix during pregnancy include:
Feel free to ask any other questions that occur to you.
Your doctor is likely to ask you a number of questions, such as: