Sometimes the cervix opens and thins early, making it unable to support a pregnancy. Learn more about this difficult-to-diagnose condition.
An incompetent cervix, also called a cervical insufficiency, occurs when weak cervical tissue causes or contributes to premature birth or the loss of an otherwise healthy pregnancy.
Before pregnancy, your cervix — the lower part of the uterus that opens to the vagina — is normally closed and firm. As pregnancy progresses and you prepare to give birth, the cervix gradually softens, decreases in length (effaces) and opens (dilates). If you have an incompetent cervix, your cervix might begin to open too soon — causing you to give birth too early.
An incompetent cervix can be difficult to diagnose and treat. If your cervix begins to open early, or you have a history of cervical insufficiency, your doctor might recommend preventive medication during pregnancy, frequent ultrasounds or a procedure that closes the cervix with strong sutures (cervical cerclage).
If you have an incompetent cervix, you may not have any signs or symptoms during early pregnancy. Some women have mild discomfort or spotting over the course of several days or weeks starting between 14 and 20 weeks of pregnancy.
Be on the lookout for:
Many women don't have a known risk factor. Risk factors for cervical insufficiency include:
An incompetent cervix poses risks for your pregnancy — particularly during the second trimester — including:
You can't prevent an incompetent cervix — but there's much you can do to promote a healthy, full-term pregnancy. For example:
If you've had an incompetent cervix during one pregnacy, 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 only be detected during pregnancy. Even then diagnosis can be difficult — particularly during a first pregnancy.
Your doctor will ask about any symptoms you're having and your medical history. Be sure to let your doctor know if you've had a pregnancy loss during the second trimester or if you had a procedure on your cervix.
Your doctor might diagnose an incompetent cervix if you have:
Tests and procedures to help diagnose an incompetent cervix during the second trimester include:
There aren't any tests that can be done before pregnancy to reliably predict an incompetent cervix. However, certain tests done before pregnancy, such as an MRI or an ultrasound, can help detect uterine abnormalities that might cause an incompetent cervix.
During a transvaginal ultrasound, your care provider or a medical technician inserts a wandlike device (transducer) into your vagina while you lie on your back on an exam table. The transducer emits sound waves that generate images of your pelvic organs.
Treatments for or approaches to managing an incompetent cervix might include:
Cervical cerclage. If you are less than 24 weeks pregnant or have a history of early premature birth and an ultrasound shows that your cervix is opening, a surgical procedure known as cervical cerclage might help prevent premature birth. During this procedure, the cervix is stitched closed with strong sutures. The sutures will be removed during the last month of pregnancy or during labor.
If you have a history of premature births that are likely due to cervical insufficiency, your doctor might also recommend cervical cerclage before your cervix begins to open (prophylactic cerclage). This procedure is typically done before week 14 of pregnancy.
Cervical cerclage isn't appropriate for everyone at risk of premature birth. The procedure isn't recommended for women carrying twins or more. Be sure to talk to your doctor about the risks and benefits of cervical cerclage.
Your doctor might also recommend the use of a device that fits inside the vagina and is designed to hold the uterus in place (pessary). A pessary can be used to help lessen pressure on the cervix. However, further research is needed to determine if a pessary is an effective treatment for cervical insufficiency.
In a cervical cerclage, strong stiches (sutures) are used to close the cervix during pregnancy to help prevent premature birth. Typically, the stitches are removed during the last month of pregnancy.
If you have an incompetent cervix, your doctor might recommend restricting sexual activity or limiting certain physical activities.
It can 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 doctor for suggestions on safe ways to relax.
If you give birth prematurely, you might also feel that you did something to cause the premature birth or that you could have done more to prevent it. If you're experiencing feelings of guilt, 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 child.
If you're pregnant and have any risk factors for an incompetent cervix or you experience any symptoms during your second trimester that indicate you might have an incompetent cervix, consult your doctor right away. Depending on the circumstances, 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 doctor.
Before your appointment, you might want to:
Below are some basic questions to ask your doctor about an incompetent cervix. If any additional questions occur to you during your visit, don't hesitate to ask.
Your doctor is likely to ask you a number of questions, including: