The high risk of cervical incompetence
Cervical incompetence (also known as cervical insufficiency) affects about 1% of all pregnancies. It is responsible for 8% of high-risk women who miscarry or have a preterm delivery during their second trimester.
Women must rely on prenatal care to understand and react immediately to this serious physical condition. Women in Los Angeles seek the expert counsel of Dr. Steve Rad, a double-board certified Obstetrician-Gynecologist with sub-specialty training in Maternal-Fetal Medicine (MFM).
Dr. Rad, who specializes in high-risk pregnancies, advises expectant mothers to remain vigilant about their conditions. Low-risk pregnancies can quickly escalate into the high-risk category.
Dr. Rad and his team at the Los Angeles Fetal and Maternal Care have decades of Perinatology experience. They are among the very best high-risk pregnancy specialists in Los Angeles, providing state-of-the-art treatments for those suffering from cervical insufficiency.
What is cervical incompetence?
This is the structural inability of the cervix to remain closed and support a growing fetus. The cervix begins to dilate (widen) and efface (shorten and thin) during the second trimester before the term is complete. When this happens, there can be a spontaneous abortion around the fourth or fifth month of pregnancy. This affects about one pregnancy in every 100, according to the American College of Obstetricians and Gynecologists (ACOG).
Cervical incompetence risk factors
Though the cause of this often-painless condition is unknown, there are several risk factors. These include:
Second-trimester pregnancy loss
Women who have already miscarried in the second trimester of a previous pregnancy are at twice the risk for cervical insufficiency.
Connective tissue disorders
Some genetic conditions affect collagen (a protein that gives the skin strength and elasticity). Women with Ehlers-Danlos syndrome or Marfan’s syndrome are at increased risk.
Exposure to diethylstilbestrol (DES)
DES is a synthetic form of the hormone estrogen. In-utero exposure to DES has been linked to cervical insufficiency.
History of cervical conditions
Women who have had precancerous lesions of the cervix and had them removed via a procedure called a cone biopsy or loop electrosurgical excision procedure (LEEP), may be at higher risk of cervical insufficiency.
Cervical trauma
Some procedures used to treat cervix abnormalities can result in cervical insufficiency. Sometimes it is a tear from a previous delivery. In other instances, it is from a pap smear or dilation and curettage (D&C).
Race
Black women are more prone to cervical incompetence.
Uterine abnormalities
Uterine abnormalities are a well-known risk factor for cervical incompetence
Signs of cervical incompetence
Cervical incompetence symptoms do not always exist during early pregnancy. It is wise to pursue prenatal treatments with Dr. Rad for a timely, accurate diagnosis. Signs of cervical incompetence may include:
- Mild discomfort or spotting between 14 and 20 weeks of gestation
- A sense of pelvic pressure
- Backache
- Abdominal cramps
- Vaginal discharge
- Light vaginal bleeding
How to diagnose cervical incompetence
Cervical insufficiency diagnosis cannot occur until one is pregnant because insufficient cervix cannot be detected until pregnancy. Even at that time, it is not easy, especially if this is the patient’s first pregnancy.
The doctor will first talk to you about your current symptoms and medical history. Alert the doctor if you have previously experienced a pregnancy loss during the second trimester.
The doctor may recommend an ultrasound or MRI to reveal abnormalities.
Reasons the doctor may diagnose a pregnant woman with an incompetent cervix include:
- The patient has a history of painless cervical dilation and second-trimester deliveries
- There is advanced cervical dilation and effacement before 24 weeks — without infection, contractions, vaginal bleeding, or water breaking
- Previous cervical laceration during labor and delivery
Call (844) 473-6100 or click here to schedule online
Testing for Cervical Incompetence
Tests that the doctor can perform during the second trimester to check for cervical incompetence include:
Transvaginal ultrasound
A transvaginal ultrasound evaluates the length of the cervix and checks for protruding membranes. The ultrasound may also show a short cervical length of 25 millimeters or less or funneling or ballooning of the membranes.
Pelvic exam
A pelvic exam reveals whether the amniotic sac is protruding through the opening of the cervix (prolapsed fetal membranes). This serious condition often leads to preterm delivery.
Imaging tests
If the fetal membranes are visible, an ultrasound may show signs of inflammation.
What is the Cervical Cerclage procedure?
Cervical cerclage is a common surgical procedure used for the management of cervical insufficiency and prevents preterm labor. A suture is used to close the cervix, with the stitch removed during the third trimester (at about 37 weeks).
The cervical cerclage procedure is effective 85 – 90% of the time.
Transabdominal cerclage is typically reserved for patients who are unable to have a transvaginal cerclage. In this process, the doctor enters the patient’s vagina through the abdomen. Transabdominal cerclage can be complicated by rupture of membranes and chorioamnionitis. It carries the added risk of intraoperative hemorrhage from the uterine veins.
The optimal time for this procedure is at the end of the first trimester (12-14 weeks).
When a patient requires a cervix cerclage later in pregnancy, it is called an emergent cerclage. If you require emergent cerclage, you will likely undergo a cervix cerclage during subsequent pregnancies.
The alternative for cervix cerclage is complete bed rest.
Cervical insufficiency complications
If left untreated by a high-risk OB, an insufficient cervix can pose a serious pregnancy risk, especially in the second trimester. Possible outcomes are pregnancy loss or preterm birth.
Cervical incompetence prevention
Though cervical incompetence is impossible to prevent, healthy living can go a long way toward achieving a full-term pregnancy.
- Have frequent prenatal care with your high-risk pregnancy specialist. Make sure to tell the doctor if you are experiencing any concerning signs or symptoms.
- Feed your body well during pregnancy. Take plenty of essential nutrients such as folic acid, calcium, and iron. A daily prenatal vitamin started a few months before conception can fill in gaps in your diet.
- Be aware of normal weight gain. Between 25 to 35 pounds is recommended as healthy pregnancy weight gain.
- Stop smoking. Don’t drink alcohol. Stop doing illicit drugs. Get the doctor’s approval if you are taking any supplements, even over-the-counter.
More about Dr. Rad
Perinatologist Dr. Rad and his world-class Maternal-Fetal Medicine (MFM) obstetrics and gynecology team at Los Angeles Fetal and Maternal Care understand your High-Risk OB and infertility needs before, during, and after birth. Our clinic provides compassionate care to help you understand your pregnancy, answer questions, and provide emotional support to safely navigate your pregnancy.
Call us at (844) 473-6100 or schedule your consultation online. We are currently accepting new patients.
We are conveniently located for patients throughout Southern California and the Los Angeles area at locations in or near Beverly Hills, Santa Monica, West Los Angeles, West Hollywood, Culver City, Hollywood, Venice, Marina del Rey, Malibu, Manhattan Beach, Newport Beach, Irvine, and Downtown Los Angeles. We also offer in-home prenatal care and a fly-in program for out-of-town and international patients. Dr. Rad even travels to patients who need him throughout the U.S. and around the world.
If you can’t make it to Dr. Rad, he also offers virtual consultations worldwide.
Call (844) 473-6100 or click here to schedule online
Cervical incompetence FAQs
What does cervical insufficiency feel like?
Cervical insufficiency often does not cause noticeable physical sensations or discomfort. Instead, cervical insufficiency is usually diagnosed based on certain signs and symptoms that may include:
- Painless Cervical Dilation
- Vaginal Pressure
- Increased Vaginal Discharge
- Backache or Pelvic Pressure
What causes cervical insufficiency?
Cervical insufficiency occurs when the cervix begins to dilate or efface (thin out) prematurely. The exact cause is not always clear, but several factors and potential contributors have been identified:
- Congenital Weakness
- Previous Cervical Trauma or Surgery
- Uterine Abnormalities
- Multiple Pregnancies
- Hormonal Factors
- Infections
- Previous Preterm Birth
How common is cervical insufficiency?
It’s estimated that cervical insufficiency occurs in about 1% to 2% of all pregnancies. However, the exact prevalence may vary depending on the population studied and the diagnostic criteria used.
Will frequent ultrasounds prevent cervical insufficiency?
Frequent ultrasounds may be used as part of the monitoring and assessment of cervical insufficiency but are not considered a preventive measure on their own. Ultrasound is often used in conjunction with clinical evaluation, cervical cerclage, and medications.
Can a doctor tell if you have cervical insufficiency?
Yes, a doctor can often diagnose cervical insufficiency, also known as an incompetent cervix, through a combination of clinical evaluation, medical history, and various diagnostic tests such as:
- Medical History
- Physical Examination
- Cervical Length Assessment
- Cervical Ultrasound
- Previous Pregnancy History
- Cervical Biopsy
Can we reverse the cervical insufficiency?
While cervical insufficiency cannot be completely reversed, there are medical interventions and treatments that can help manage and reduce the risk of complications. Though, the effectiveness of interventions may vary from person to person.
Does misoprostol cause cervical insufficiency?
There is no direct evidence to suggest that misoprostol causes cervical insufficiency.
How can you prevent cervical insufficiency?
Cervical insufficiency cannot always be prevented as it is often related to structural or anatomical factors. However, there are some strategies that may help reduce the risk of cervical insufficiency or identify it early for appropriate management:
- Preconception Counseling
- Cervical Length Assessment
- Cervical Cerclage
- Progesterone Supplementation
- Lifestyle Factors
- Prenatal Care
Is cervical insufficiency hereditary?
Cervical insufficiency is not typically considered a strongly hereditary condition. It is a complex condition, and its exact causes can vary from person to person.
