Facts about a rare and often silent condition that causes pre-term birth and miscarriage in an otherwise healthy pregnancy.
In a nutshell, pregnancy or gestation is to grow a baby. So, the expectant mother’s aim is to carry the baby to term (generally defined as 37 to 42 weeks from the day of a woman’s last period).
If you’re pregnant, your cervix should ideally remain tightly closed until just before baby is born. As the pregnancy progresses and you prepare to give birth, the cervix gradually softens, decreases in length (effaces) and opens (dilates).
When the cervix becomes too weak and opens before it is supposed to, this condition is known as an “incompetent cervix”. This can lead to late miscarriage (typically in the second or third trimester) or premature delivery.
“I had four miscarriages prior to being diagnosed with a weak cervix. Becoming pregnant became a thing to worry about, rather than rejoice, as we did not know if the foetus could make it to full term.”
Worldwide studies show that cervical incompetence occurs in about 1 per cent of pregnancies, notes obstetrician and gynaecologist Dr Liana Koe of STO+G Practice at Thomson Medical. While this condition is actually rare, the American Pregnancy Association says that it contributes to “almost 25 per cent of babies miscarried in the second trimester”.
But there’s hope for those who suffer from cervical incompetency. Says stay-at-home mum Jacqueline Chan, 36, “I had four miscarriages prior to being diagnosed with a weak cervix. Becoming pregnant became a thing to worry about, rather than rejoice, as we did not know if the foetus could make it to full term.”
After being diagnosed with cervical incompetency, she underwent a cerclage (more details below) procedure, after which she was able to carry two baby girls to term successfully.
Dr Koe has more details about this condition:
What are the symptoms of an incompetent cervix?
There are almost no symptoms as the cervix opens painlessly. Transvaginal ultrasound scans of the cervix done during pregnancy in the second trimester can detect the shortening of the cervix, which can be a marker for pre-term delivery, which is typically defined as giving birth at less than 37 weeks gestation. However, this does not directly indicate underlying cervical incompetence. Such scans are reserved for women who have a history of painless cervical opening leading to a pregnancy loss.
That said, the renowned Mayo Clinic in the US observes that some women have mild discomfort or spotting over the course of several days or weeks starting at between 14 and 20 weeks of pregnancy.
Other signs to look out for include:
* A sensation of pelvic pressure.
* A new backache.
* Mild abdominal cramps.
* A change in vaginal discharge.
What are the risk factors for cervical incompetence?
Women may stand a higher chance of this condition if they have:
* Had previous surgery to the cervix, such as treatment for previous abnormal Pap smears requiring cone biopsies.
* A previous pregnancy loss in the second trimester (before 24 weeks’ gestation) or pre-term delivery before 34 weeks of pregnancy.
* A prior history of waters breaking before 37 weeks of pregnancy.
In some women with a strong history suggestive of cervical incompetence leading to pregnancy loss, a cervical stitch can be put in the early second trimester as a precaution.
How can doctors help women who have an incompetent cervix?
If you have any risk factors, your doctor will usually recommend transvaginal ultrasound scans to measure your cervix during your pregnancy. If there is any sign that the of the cervix is shortening ― to less than 25mm ― you may be offered various options, such as:
* Hormone medication known as progesterone, which are to be inserted vaginally.
* A procedure to put in a cervical stitch to keep the cervix closed, and hopefully, prevent loss of pregnancy or pre-term delivery. A cervical stitch, or cerclage, refers to procedures that use sutures or synthetic tape to reinforce the cervix during pregnancy.
In certain women with a strong history of pregnancy loss arising from cervical incompetence, a cervical stitch can be put as a precaution early in the second trimester.
Other than this, bed rest or pelvic rest (refrain from sex) may also be prescribed.
How is the cervical cerclage procedure carried out?
A doctor will stitch a band of strong thread around the cervix, then tighten it to ensure that the cervix is firmly closed, according to the American Pregnancy Association. To manage the pain during the procedure Most women are under general or spinal anaesthesia, or get an epidural, to. You may stay in the hospital for several hours or overnight to be monitored for premature contractions or labour.
The stitches are usually removed at week 37 of the pregnancy in the ob-gyn’s office without any problems. This procedure is similar to getting a Pap smear.
Photos: iStock
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