Cervical Incompetence: Presentation, Causes, Diagnosis and Management

By Dr Olaomo Noah O

This refers to the inability of the cervix (neck of the uterus) to support a pregnancy to term (9months) due to its weakness.

The cervix provides a strong mechanical support to the growing pregnancy. It should remain closed and long enough in length till term. However, in some instances, the cervix is weak and could not sufficiently supports the weight of the growing pregnancy. This results in miscarriage.
OTHER NAMES: It is also known as CERVICAL INSUFFICIENCY.

WHEN DOES IT OCCUR
Miscarriage from cervical incompetence usually occurs in the second trimester. It can also occur as a preterm delivery in the early third trimester.

HOW DOES IT PRESENT
It usually presents as;
•Painless drainage of water as from second trimester.

•Followed by bleeding and expulsion of products of pregnancy

•Previous history of similar occurrence.

CAUSES OF CERVICAL INCOMPETENCE.
Cervical incompetence can result from;
1. Previous injuries to the cervix from any of the following;
a. Improperly done abortion and evacuation (D&C).
b. Injuries to the cervix at childbirth ( cervical tear)
c. Surgeries done on the cervix e.g surgeries on very early stages of cervical cancer.

2. Congenital (inborn)
weakness of the cervix.
Some women are born with weakness of the cervix. An example is women who are exposed to a drug called DES (Diethyl stilbesterol) while in the womb.

3. Diseases affecting connective tissues of the body can also cause an incompetent cervix.

DIAGNOSIS
The diagnosis can be made through;

•The medical history of the patient: Some women when they present might have had one or more midtrimester miscarriage

•Ultrasound measurement of the cervix. Some women who would eventually developed cervical incompetence can be picked up early through the measurement of their cervical length. If the cervical length is shorter than expected, it may be suggestive of cervical incompetence and can also predict preterm delivery.

MANAGEMENT

The management of cervical incompetence is by placement of cervical cerclage. Cervical cerclage is also known as cervical stitch. This is usually done from 13weeks up to about 24weeks (usually).
It is usually preferably done between 13-15weeks.