Cervical Incompetence
Cervical incompetence, also known as cervical insufficiency, is a condition characterized by the inability of the cervix to retain a pregnancy, particularly during the second trimester, leading to spontaneous pregnancy loss or preterm birth. Understanding its causes, risk factors, symptoms, diagnosis, and management is crucial for the prevention of pregnancy complications and the preservation of maternal and fetal health.
Causes and Risk Factors
Cervical incompetence may be caused by various factors, including:
- Congenital Factors: Structural abnormalities of the cervix present from birth can weaken its ability to support a pregnancy.
- Previous Cervical Trauma: Surgical procedures such as cone biopsy or dilation and curettage (D&C) may weaken the cervix, increasing the risk of incompetence.
- Multiple Pregnancies: Women carrying multiple fetuses may experience increased pressure on the cervix, leading to cervical incompetence.
- Hormonal Factors: Changes in hormone levels, particularly progesterone, during pregnancy can affect cervical integrity and function.
Symptoms
Cervical incompetence may not cause noticeable symptoms in the early stages. However, symptoms that may indicate cervical incompetence include:
- Recurrent Pregnancy Loss: Multiple spontaneous pregnancy losses, typically occurring during the second trimester, may suggest cervical incompetence.
- Painless Cervical Dilation: In some cases, cervical dilation may occur without contractions or other signs of labor.
Diagnosis
Diagnosing cervical incompetence often involves a combination of medical history, physical examination, and imaging studies, including:
- Transvaginal Ultrasound: Ultrasound imaging can assess cervical length and detect signs of cervical dilation or funneling.
- Cervical Exam: A pelvic exam may reveal changes in cervical consistency, effacement, or dilation.
- Medical History: A history of previous pregnancy losses, preterm births, or cervical procedures can provide valuable diagnostic information.
Management and Treatment
Management strategies for cervical incompetence aim to provide mechanical support to the cervix and prevent preterm birth, and may include:
- Cervical Cerclage: A surgical procedure in which a stitch is placed around the cervix to provide mechanical support and prevent premature cervical dilation.
- Progesterone Supplementation: Hormonal therapy with progesterone may be used to support cervical integrity and reduce the risk of preterm birth.
- Bed Rest and Activity Restrictions: Limiting physical activity and avoiding strenuous exercise may help reduce pressure on the cervix and prevent preterm labor.