Incompetent cervix (IC), also known as cervical insufficiency or weakened cervix, happens when your cervix dilates (widens) and effaces (thins and shortens) too early during pregnancy. This usually happens without pain or contractions and can be a silent condition.
A weakened cervix happens in approximately 1% of pregnancies and is attributed to nearly 20% of babies lost in the second trimester.
Cervical insufficiencies have few remedies, there is no cure, and can only be diagnosed in pregnancy.
Cervical insufficiency ended my pregnancy at 21 weeks and 2 days.
Disclaimer: I am not a medical professional and I am sharing my experiences of cervical insufficiencies. If you have questions or concerns regarding your health, the health of your baby, or your pregnancy, please contact your doctor with questions. If this is an emergency, please seek medical treatment immediately.
What Causes an Incompetent Cervix?
Cervical insufficiencies happen when the pressure of your growing uterus in pregnancy puts weight on your cervix that it cannot bear.
There isn’t a test to see if you will have a weakened cervix.
It is a nightmare diagnosis that can lead to pregnancy loss, preterm labor, and extensive NICU time for your premature baby.
Cervical insufficiency changed my life in 2018. My husband and I were preparing to welcome twin girls when I had painless dilation that caused preterm labor, and subsequently, the loss of our daughters. It was my first pregnancy and I didn’t have any risk factors.
You can be at higher risk for a weakened cervix in pregnancy if you’ve experienced any of the following:
- Cervical issues in prior pregnancy with or without a cerclage
- Short cervix prior to 24 weeks, with or without pre-term labor
- You’ve had a cone biopsy of the cervix or a LEEP procedure
- History of second-trimester pregnancy loss with painless dilation
- Opening of the cervix in your second trimester with painless dilation
- Collagen disorders
- Uterine abnormalities
- Your cervix has injuries from having one or more abortions in the past
Once diagnosed with IC, many women are left scrambling and searching for answers.
My cervical issues were found during our anatomy scan at 21 weeks.
I was monitored and sent home without any solution. I went into preterm labor within 48 hours of my diagnosis.
Monitor your pregnancy symptoms and reach out to your doctor with any questions, big or small. Symptoms of IC are hard to recognize and many times this is a silent condition with devastating effects for you and your baby.
What are the Symptoms of a Weakened Cervix?
If you believe you have symptoms of a weak cervix, which can be vast and present as common pregnancy symptoms, and you are pregnant, please make an appointment with your doctor.
Knowing the signs of an incompetent cervix is important when you are pregnant.
If you are pregnant, it’s important to not dismiss symptoms as pregnancy symptoms without discussing them with your physician.
Some symptoms of an incompetent cervix may include:
- Pressure in your pelvis
- Backache
- Abdominal cramps
- Discharge
- Bleeding
Unfortunately, symptoms of an incompetent cervix can be masked as pregnancy symptoms. The key is to get a diagnosis early to see if any intervention is possible. If you have any symptoms you are questioning, reach out to your doctor.
In the days leading up to our scan where IC was discovered, I didn’t experience any symptoms that I didn’t attribute to pregnancy.
What are treatments for IC?
While there isn’t one cure for an incompetent cervix, there are a few things that may be done to try to delay labor and keep your baby in as long as possible.
- Frequent ultrasounds
- Cervical lengths can change quickly. With regular monitoring, the hope is to identify a shortening cervix as soon as possible
- Progesterone supplementation
- The success rates in beating IC with the use of progesterone have the medical community divided, however, it is used to help reduce the risk of premature birth
- Bedrest
- Bedrest can help reduce the weight on your cervix
- Cerclage
- A way to keep the cervix closed during pregnancy.
What is a Cerclage?
A cerclage is a way to keep the cervix closed during pregnancy.
There are several types of a cerclage that can be placed. A transvaginal cerclage (TVC), is the most common procedure to stitch the cervix closed. It is typically placed at the end of the first trimester or the beginning of the second trimester in pregnancy when there is a history of IC.
An emergent transvaginal cerclage, in some cases, can also be placed once IC is detected in pregnancy.
A transabdominal cerclage (TAC), is another way to help keep the cervix closed. This procedure is done through the belly and places a band or bands around the lower part of the uterus. A C-section is required to deliver a baby using this method and this can be placed pre-pregnancy or during pregnancy.
A transabdominal cerclage can be permanent and the bands can remain in place for all pregnancies.
Recommendations vary between doctors as far as what treatments should be attempted once an incompetent cervix is detected and in subsequent pregnancies.
Some doctors believe there should be two second-trimester losses before attempting a more invasive procedure such as a transabdominal cerclage, however, when working with my surgeon, she would only suggest the TAC procedure over a vaginal cerclage based on success rates.
Why does an incompetent cervix lead to miscarriage?
When your cervix is open it can cause several issues including bulging membranes, infection, contractions, and preterm labor.
As in any medical diagnosis, please advocate for yourself. An incompetent cervix is a painful diagnosis. Each pregnancy is different and every doctor has different experiences and recommendations. If you are not comfortable with your treatment plan, find a second opinion.
In an article published by the Chicago Tribute, Dr. Laura Doulass with the University of Chicago says, “I think in the medical community there’s a lot of discussion and perhaps not agreement about, can you truly label something incompetent cervix?… What about preterm labor, what about an infection, and a lot of argument about what the initial catalyst is.”
March 4th is Incompetent Cervix Awareness Day.
I’ve felt a strong calling to share our story. I’ve read and listened to so many other families and mothers share their experiences over the years.
As I find my voice, I will continue to share our story. Our story is sad, traumatic, and beautiful.
Life after loss is complicated and the healing never ends. I hope to shed some light on important issues that have touched my life as I am grieving and growing through infertility.
Disclaimer: I am not a medical professional and I am sharing my experiences of cervical insufficiencies. If you have questions or concerns regarding your health, the health of your baby, or your pregnancy, please contact your doctor with questions. If this is an emergency, please seek medical treatment immediately.