Incompetent Cervix: Symptoms, Risk Factors, Diagnosis, Treatment, Prevention and Complications

An incompetent cervix develops when poor cervical tissue leads to an early delivery or the caesarean section of a healthy pregnancy. Cervical insufficiency is another term used to describe an incompetent cervix.

The cervix is the lowest part of the uterus that protrudes into the vagina. It's usually closed and rigid before getting pregnant. As the pregnancy goes on as you get ready to give birth, the cervix gradually changes. It softens, opens up, and gets shorter. If your cervix is incompetent, it may open prematurely, which could result in an early delivery.

Diagnosing and treating  Cervix incompetence can be difficult. If you have ever had cervix insufficiency or if your cervix opens early, you might benefit from treatment. This could mean having a cervical cerclage, which is a surgical procedure in which the cervix is closed with strong sutures. You could also take medicine to help the incompetent cervix and get ultrasound exams to monitor the situation.

Symptoms Of Incompetent Cervix

In the early stages of pregnancy, an incompetent cervix may not cause any symptoms or signs. Some women experience little pain or spotting before the diagnosis. This typically occurs earlier than the 24-week pregnancy milestone.

Be careful for:

• A feeling of pressure within the hips.
• Fresh pain in the back.
• Slight cramping in the stomach.
• Changes in the vaginal secretions.
• Little vaginal bleeding.

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Risk Factors Of Incompetent Cervix

Many women do not have a known risk factor. Risk factors for an incompetent cervix include the following:

• Cervical trauma: A history of cervical surgery or treatments may lead to an incompetent cervix. This entails undergoing surgery to address a cervical problem that a Pap test identified. A dilatation and curettage (D&C) procedure may also be associated with an incompetent cervix. Rarely, a cervical tear from a previous delivery may raise the risk of an incompetent cervix.
• A medical condition that you have from birth: This is what we call a congenital condition. Certain uterine disorders can lead to cervix incompetentia. Genetic abnormalities affecting collagen, a kind of protein that makes up your body's connective tissues. can cause an incompetent cervix.

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Diagnosis Of Incompetent Cervix

It is possible to discover an incompetent cervix only during pregnancy. It can be difficult to make this diagnosis, especially if it's a first pregnancy.

Your doctor or another member of your care team may ask you about your symptoms and medical history. Make sure your care team is informed if you have ever experienced a preterm delivery or if you have ever lost a pregnancy in the second trimester. Tell your medical staff about any cervical surgeries you have had as well.

Your doctor may diagnose you with an incompetent cervix if you have:

• A history of painless cervical dilation and second-trimester delivery from a prior pregnancy.
• Cervical dilatation and effacement progressed before week 24 of pregnancy. The term "effacement" describes a softer, thinner cervix. Cervical dilatation and effacement can occur without painful contractions in every case. They can also be brought on by infections, ruptured membranes, or vaginal bleeding, which is the breaking of the water.

An incompetent cervix diagnosed in the second trimester may also include:

• An ultrasonic analysis: During this test, a thin, wand-like instrument called a transducer is put into your vagina. This is referred to as transvaginal ultrasound. The transducer emits sound waves that are converted into visual pictures that show up on a screen. You can determine the length of your cervix and whether any tissues protrude from it with this type of ultrasonography.
• An examination of the pelvis: In a pelvic exam, your doctor feels through the opening in the cervix to feel for the amniotic sac. Inside the amniotic sac, the baby is developing. The cervical opening is indicated by prolapsed foetal membranes, which happen when the sac wall is in the vaginal or cervical canal. Your doctor might also check on you to make sure your contractions are occurring if needed.
• Lab experiments: Further testing might be necessary in the event of prolapsed foetal membranes to rule out an infection. Sometimes, this can mean taking a sample of amniotic fluid. We call it amniocentesis. One helpful method for checking for infections in the amniotic sac is amniocentesis.
• There is no reliable test to find out if you will have an incompetent cervix before getting pregnant. MRIs and ultrasounds, on the other hand, may be able to detect uterine congenital abnormalities that may result in an incompetent cervix during pregnancy.

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Treatment Of Incompetent Cervix

The following therapies are some ways to manage an incompetent cervix:

• Progesterone supplementation: Women with short cervixes who have never given birth previously can lower their risk of preterm delivery by using vaginal progesterone. This drug is taken once a day as a gel or suppository through the vagina.
• Several ultrasounds: If you have a history of early preterm delivery or any other condition that increases your risk of an incompetent cervix, your doctor may closely monitor the length of your cervix. To do this, you get ultrasounds every two weeks from week 16 to week 24 of pregnancy. If your cervix shortens below a certain length or begins to open up, you may need a cervical ligation.
• Cervical cerclage: During this procedure, the cervix is kept shut with a tight stitch. The stitches are taken out during the last month of pregnancy or just before delivery. A cervical cerclage may be necessary if you are less than 24 weeks pregnant, have a history of preterm deliveries, and an ultrasound shows that your cervix is starting to open.

Sometimes, cervical cerclage is done as a preventive measure before the cervix opens. We call this kind of cervical cerclage "preventive." You might undergo this type of cervical cerclage if you have previously become pregnant while having an incompetent cervix. Usually, a pregnancy is ended before the fourteenth week.

Not every person at risk of preterm birth should choose cervical cerclage. For example, if you are expecting twins or more, surgery is not advised. Make sure you discuss the potential risks and benefits of cervical cerclage with your physician.

• Pessary: The uterus is held in place by a device called a pessary that inserts into the vagina. Using a pessary could relieve some of the cervix's pressure. However, more investigation is required to determine whether a pessary is effective in treating an incompetent cervix.

Also Read: Placenta Accreta: Causes, Symptoms, Risk Factors, Diagnosis, Treatment and Complications

Prevention Of Incompetent Cervix

It is impossible to prevent an incompetent cervix. You may take a lot of steps, nevertheless, to guarantee a healthy, full-term pregnancy. To give an example:

• Frequently seek out maternity care: Regular prenatal appointments allow your medical team to monitor the health of both you and your unborn child. No matter how trivial or outlandish they may seem, talk to your doctor about any symptoms or concerns you have.
• Eat a balanced diet: Throughout your pregnancy, you'll need more calcium, iron, folic acid, and other essential nutrients. A daily prenatal vitamin can help if you're not eating enough nutritious meals. You can begin taking prenatal vitamins a few months prior to getting pregnant and keep taking them all the way through.
• Gain weight in a sensible manner: Your baby's development may benefit from a healthy weight gain. Goal weight increase is typically 25 to 35 pounds, or 11 to 16 kilogrammes if you were at a healthy weight before being pregnant.
• Avoid contact with hazardous chemicals: If you smoke, stop now. Alcohol and illicit drugs are also forbidden. Obtain your doctor's consent before beginning any medicine or supplement regimen, even if it is over-the-counter.
• If you had an incompetent cervix in your first pregnancy, you have an increased chance of miscarriage or an early birth in subsequent pregnancies. If you're considering becoming pregnant again, see your doctor so that you can find out more about the risks and how to have a safe pregnancy.

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Complications Of Incompetent Cervix

If your cervix is incompetent, it might risk your pregnancy. Among the possible problems are:

• Early birth.
• Miscarried pregnancy.

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