Signs of an Incompetent Cervix

Cervical Insufficiency Causes Some Recurrent Late Pregnancy Losses

Shoulder To Cry On
ClarkandCompany/Getty Images

One of the few recognized causes of late pregnancy losses is a condition called cervical insufficiency, often referred to as incompetent cervix.

About 80 percent of all pregnancy losses occur in the first trimester, but a small fraction of women will suffer miscarriage or stillbirth in the second or third trimester. The majority of late pregnancy losses are never explained, but researchers have identified some factors that can cause women to suffer recurrent late miscarriages.

A woman with cervical insufficiency may experience preterm births or late pregnancy losses due to her cervix starting to dilate too early in the pregnancy. In cases when the problem isn't caught in advance and treated, the early dilation leads to an early delivery of the baby that can't be stopped by intervention. Often the baby is born too early for it to survive. 

You may be at risk for cervical insufficiency if you have irregularities in your cervix or uterus. These may be present at birth or, more usually, may occur as the result of traumas such as surgery.

Can Incompetent Cervix Cause Recurrent First-Trimester Miscarriages?

No, cervical insufficiency wouldn't be a factor in a first-trimester miscarriage. A woman with cervical insufficiency would start to dilate as the baby grew larger and began to place more pressure on the cervix. In the first trimester, the developing baby is too small for this to be an issue.

If you are having recurrent first-trimester miscarriages, you should talk to your doctor about being tested for recurrent miscarriage causes. It is not likely that cervical insufficiency will be the explanation in your case, though.

Symptoms of Incompetent Cervix

If you've had one or more second-trimester miscarriages or preterm births, you may be wondering whether you might have cervical insufficiency.

How can you tell if it might be an explanation for your situation? Unfortunately, catching cervical insufficiency early can be tricky. 

You may have no symptoms at all. Or, starting between weeks 14 and 20, you may experience any of the following mild symptoms:

Treatment for Cervical Insufficiency

Treatment practices vary among physicians, mainly due to the lack of clear evidence indicating a specific course of action.

Some doctors will recommend placement of a cervical cerclage (a stitch to help hold the cervix closed) as a precautionary measure early in the pregnancy. Other doctors will recommend close monitoring and place an emergency cerclage if needed.

Although some studies show benefits to cerclage in preventing early delivery, there's a lot of conflicting evidence on which women will benefit from it and when in pregnancy it is best to place the cerclage.

Many doctors also use progesterone supplements (hydroxyprogesterone caproate) to help prevent early delivery, either alone or combined with cerclage.

 

Testing and Diagnosis

Unfortunately, there's no reliable test for cervical insufficiency in women who aren't pregnant.

If you've had multiple second-trimester miscarriages or stillbirths, it's worth asking your doctor about whether you might be at risk. If you have delivered quickly in your past pregnancies or if you have been going into labor earlier with each pregnancy, you should share your concerns with your doctor and discuss whether you need monitoring for incompetent cervix in future pregnancies. 

In women who are pregnant and who have a history preterm delivery that may be related to cervical insufficiency, doctors can screen for symptoms in the early second trimester with a pelvic exam and an ultrasound to look for a short cervix, among other factors. There is no lab test. 

When Your Doctor Won't Screen

However, not all doctors will screen for cervical insufficiency until after the second pregnancy loss. Having a short cervix on ultrasound isn't always predictive of preterm birth, and screening women at low-risk could lead to unnecessary interventions.

From a patient's perspective, it can seem almost cruel when a doctor tells you that you have to miscarry again before you can be tested for treatable causes. With conditions like cervical insufficiency, the diagnostic criteria are still unclear. What's normal in one person can be signs of problems in another. And there are risks - some serious - to using intervention in people who don't really need it. 

Talk out the situation with your doctor and, if it would help you feel more comfortable, get a second opinion. 

Source:

Cervical insufficiency. UpToDate. January 4, 2016.

Continue Reading