Cervical insufficiency, or a weakness of the cervix, is the shortening of the cervix or its dilatation by more than 1 cm in the second or third trimester. Doctors pay attention to this condition because it can lead to premature birth.
What causes cervical insufficiency?
Real, congenital weakness of the cervix due to a lack of collagen is quite rare. More often, cervical insufficiency has external (mainly preventable) causes [1], such as:
inflammation or infection of the genital tract;
excessive stretching of the uterus (for example, due to polyhydramnios or twins);
injury to the cervix as a result of previous childbirth, abortion or surgery.
Risk factors that can contribute to premature shortening or dilatation of the cervix also include:
obesity;
iron-deficiency anemia;
polycystic ovary syndrome;
a history of luteal phase failure.
What symptoms should I look out for?
You should alert your doctor if you experience any of the following:
shooting pain in the vagina;
pulling pain in the lower abdomen;
mucous discharge streaked with blood.
However, the dilation of the cervix can occur asymptomatically and can cause a mother to go into early labor [1]. Therefore, it is preferable that your doctor performs a transvaginal ultrasound during screening of the second trimester to assess the condition of the cervix. For those at risk, it makes sense to repeat the ultrasound scan two weeks after screening.
With cervical insufficiency, can premature birth be avoided?
Yes. With your doctor you will be able to determine the cause of the weakness and then you can choose the right treatment. For examples, antibiotics will be prescribed if the cause is an infection [2].
If cervical insufficiency is due to hormonal causes, progesterone is prescribed and injected directly into the vagina [1].
In cases where medications cannot be found or there is no time for treatment, a cerclage can be performed, which stitches the cervix to prevent it from opening.
Another way to prevent premature birth is to have an obstetric pessary inserted. This is a silicone hypoallergenic ring. It is inserted into the vagina and changes the angle between the uterus and the cervix. As a result, the pressure decreases and the opening stops [3].
