It’s very worrying to be told you have signs of an incompetent cervix.
The goal for every woman is to have a healthy pregnancy and give birth when her baby is full term.
But signs of an incompetent cervix can change that.
What Are The Signs Of An Incompetent Cervix?
Fortunately the condition is rare and happens in only about 1 in 100 pregnancies and is responsible for about 20% of all second trimester losses (the loss of an otherwise healthy baby after 28 weeks of pregnancy).
If you know the risk factors and can recognise the signs of an incompetent cervix, you might feel more reassured.
What Is An Incompetent Cervix?
During pregnancy, your cervix is closed.
Towards the end of pregnancy, your cervix starts to change.
It will soften, begin to shorten and thin (effacement), and to dilate.
An incompetent cervix is one that opens too soon; it can cause preterm birth.
Incompetent cervix is also known as cervical insufficiency.
It can happen very quickly and with minimal or no contractions.
The reason for incompetent cervix is not well understood but experts believe it’s a combination of:
- Weakness of cervical tissue
- Structural abnormalities
- Inflammation and/or infection.
Many women don’t have known risk factors for incompetent cervix.
This can often mean women aren’t diagnosed with cervical insufficiency until it’s happened one or more times.
Who Is At Risk For Incompetent Cervix?
During early pregnancy, miscarriages are generally due to problems with the developing fetus, such as chromosomal abnormalities.
However, cervical insufficiency is thought to be responsible for 25% of second trimester pregnancy losses.
Overall, incompetent cervix occurs in about 1 in every 100 pregnancies.
For many women, there are rarely any warning signs before it happens.
But there are some risk factors that make the condition more likely to occur:
- Cervix damage that happened during a difficult birth
- Previous surgery on the cervix, such as a cervical cone biopsy
- Previous D&C (dilation and curettage) which caused trauma to the cervix
- Exposure to Diethylstilbestrol (DES), a synthetic estrogen, used from the late 19030s until the early 1980s to prevent miscarriage and pregnancy complications. DES caused reproductive tract problems in 30% of the daughters of women who took it during pregnancy.
- One or more previous second trimester miscarriages with unknown causes.
- Uterine abnormalities or cervix malformations.
- Incompetent cervix in a previous pregnancy.
If you are at risk for cervical insufficiency, your care provider might suggest regular ultrasounds from 16 weeks gestation.
Depending on your situation, your care provider can also make suggestions for treatment.
What Are The Symptoms Of Incompetent Cervix?
Typically, incompetent cervix occurs without pain or contractions.
However, some women experience signs of incompetent cervix.
Many of the symptoms below are similar to those normally experienced during pregnancy.
You should seek advice from your care provider if you are in your second trimester and experience one or more of the following:
#1: Changes To Vaginal Discharge
It’s quite normal to have some vaginal discharge during pregnancy.
This is usually a thin, white, milky fluid.
If you notice your vaginal discharge is thicker, and has pink, brown or red in it, this can indicate your cervix is dilating.
#2: Spotting Or Vaginal Bleeding
Many women experience some spotting or light bleeding in the first three months of pregnancy.
It’s unsettling and can cause a lot of worry but in most cases it will settle and disappear.
If your cervix begins to dilate spontaneously in the second trimester, small blood vessels break. This causes spotting or light bleeding.
Always contact your care provider if you have any vaginal spotting or bleeding in the second trimester.
#3: Pressure in Pelvis
Mild pelvic pressure is normal during pregnancy.
If it increases and feels intense then it should be investigated.
Pelvic pressure can feel like something is falling out of, or being pushed into, the vagina.
The sensation might feel quite strong when you’re standing up, and ease up when you lie down.
Back pain is almost an expected symptom of pregnancy.
It is more common when your baby begins to grow and shift your centre of gravity.
Always seek medical advice if you experience pain that occurs in the lower back, and is constant – especially if it’s accompanied by bleeding or cramping.
Again, cramping is a pregnancy symptom that is easy to dismiss as normal.
It’s important to note the type of cramps you are feeling and their frequency.
Are they constant or rhythmic? Do they ease off if you lie down or get worse when you move about?
Cramps associated with cervical dilation usually feel similar to the type you feel during your period.
Diagnosing Incompetent Cervix
If you suspect you’re experiencing cervical insufficiency, seek immediate assistance from your care provider.
Treatment is possible if you act quickly.
You will have an ultrasound to measure the length of your cervix.
Your care provider will check for signs your cervix is thinning and dilating.
The most common way to treat incompetent cervix is by inserting a stitch.
This is called a transabdominal cerclage. It holds the cervix closed.
As your pregnancy progresses, you will need regular check ups to assess your cervical length.
Can I Prevent Incompetent Cervix?
We don’t know what causes cervical insufficiency; therefore it’s impossible to prevent it from happening.
The old advice was to have bed rest but that hasn’t been shown to be effective in preventing cervical insufficiency.
There are other things you can do to ensure you have a healthy pregnancy. This is particularly important if you have known risk factors for cervical insufficiency.
You should do the following:
- Eat a healthy diet; limit processed foods, which can interfere with your intake of folate, iron, magnesium and other essential nutrients.
- Keep active and well, by including moderate exercise as part of your pregnancy care.
- Avoid taking recreational or risky substances, such as nicotine, alcohol and illegal drugs. Check with your care provider before taking medications or supplements.
- Have regular prenatal appointments; this will help your care provider monitor your wellbeing and keep track of any potential problems.
It can be difficult to discover you have experienced cervical insufficiency.
You’re likely to feel concerned about your baby and any future pregnancies.
It’s important you speak to your care provider about your concerns and ask as many questions as you need to.
It’s common for women with an incompetent cervix to feel they have done something to cause the condition, or to wonder whether they could’ve prevented it from happening.
Remember, cervical insufficiency is hard to diagnose and prevent. Seek support if you are finding it difficult to accept what is happening.