What is cervical insufficiency?

Cervical insufficiency (sometimes called incompetent cervix) refers to a cervix that opens too early during pregnancy, usually without pain and contractions. This most often occurs in the second or early third trimester of pregnancy, resulting in late miscarriage or premature birth. A woman may be diagnosed with cervical insufficiency based largely on this history. There is no specific diagnostic test.

Medical experts don’t always know why cervical insufficiency occurs. Factors that may contribute include:
• Uterine defects: Women with certain uterine defects, such as bicornuate uterus (two cavities), are more likely to have cervical insufficiency than women without these defects.
• History of surgical procedures involving the cervix: These include LEEP (loop electrosurgical excision procedure), which is used to diagnose and treat abnormal cells found during a Pap test.
• Injuries during a previous birth.
• Short cervix: The shorter the cervix, the more likely the woman is to have cervical insufficiency. In some cases, a short cervix can be congenital.

Miscarriage and premature birth due to cervical insufficiency frequently happen again in another pregnancy. These problems can sometimes be prevented with a procedure called cerclage, in which the provider places a stitch in the cervix to keep it from opening too early. The provider removes the stitch when the woman is ready to give birth.

It is not always clear which women will benefit from cerclage. This is because there is no specific test for cervical insufficiency, and many women who have had a late miscarriage or early premature birth go on to have normal pregnancies without treatment. Some studies suggest that cerclage is most likely to be beneficial in women who have had three or more late miscarriages or premature births. In some cases, providers may monitor a woman suspected of having cervical insufficiency with repeated vaginal ultrasounds to see if her cervix is shortening or showing other signs that she may give birth soon. The provider may recommend cerclage if these changes occur.

Some women learn that they have a short cervix during a routine ultrasound. Most of these women do not end up having a premature birth. However, short cervix, especially a very short cervix (less than 15 millimeters), does increase her risk of premature birth. Studies suggest that treatment with the hormone progesterone (17P) may help reduce the risk of premature birth in women with a very short cervix. According to the American College of Obstetricians and Gynecologists (ACOG), progesterone treatment may be considered for these women. However, ACOG does not recommend routine cervical-length screening for low-risk women.

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11 Responses to “What is cervical insufficiency?”

  1. Jacklyn Says:

    I have had 4 pregnancies and only one of the 4 made it past 20 weeks,My son Kamden was born @ 25 weeks..I did have the cerclage and the progestrone and was in the hospital for the entire month of October 2008 and he was still born early. No doctor knows whats wrong with me and told me i’m likely to miscarry or have a preterm child if I do end up pregent again…Just thought i’d share that with all…

  2. Kristin Klokkervold Says:

    Many women have multiple losses before being diagnosed with IC, so I have been ‘lucky’ only to have 1 angel.

    I was diagnosed with IC in October 2008 after my daughter was born and died at 21 weeks. I did have a rescue vaginal cerclage – TVC (stitch) that failed. And my world fell apart.

    I then got a permanent stitch in August 2009 before falling pregnant again (Trans Abdominal Cerclage – TAC). I’m now 27 weeks in a perfectly normal pregnancy all because of the TAC = no bedrest, no infections, working full time, because cervix is now forever long and closed.

    IC causes 20-25% of all 2nd trimester losses and micro premmie babies, but no research has proved why it happens and if it is hereditary.

    Most doctors knows very little about IC and cerclage options, be your own advocate and do your own research, and you too can have a full term pregnancy despite IC.

    More info on IC : ‘incompetent cervix forum’.
    More info on TAC : ‘abbyloopers forum’.

    Hugs to all xo
    Kristin

  3. Renee Says:

    I have had 2 cerclage babies, one preemie and one full term. With s cerclage and bedrest ( if necessary) you can have a wonderful pregnancy. Good luck to all ladies out there with IC, healthy babies are possible. 🙂

  4. Amy Says:

    Ladies, if you have suffered a loss due to IC, there is HOPE! Please do not listen to ANYONE who tells you that you need to lose more than one child to find a solution. The TAC (transabdominal cerclage) is a solution for IC. You will have a “bionic cervix,” even stronger than a “normal” woman. I lost 2 boys due to IC before I found out about the TAC. After I had the TAC (in pregnancy with my daughter) I delivered a beautiful 9 pound baby girl FULL TERM with no complications!!!! My cervix was long and closed for 37 weeks. No bed rest, no time off work, no restrictions. Now I am pregnant with my fourth child, and my TAC will work this time too–no more surgeries needed! I strongly recommend visiting http://www.abbyloopers.org if you have more questions.

  5. julianne Says:

    Please mention that there is another procedure called a TAC — a transabdominal cerclage. It’s a permanent cerclage and it could save lives.

    I wish I had known about it before I had my son at 23 weeks — he only lived for 8 days.

  6. Lindsay Says:

    Yes, thank you for mentioning the transabdominal cerclage. It has helped many women. Not all doctors perform this surgical procedure and not all insurance companies cover it, but it is worth talking to your provider about it if you have had a previous loss due to incompetent cervix.

  7. Fawzia Poonah Says:

    I have had two second trimester losses due to IC.
    In 2008 I lost my daughter at 20w3d and was diagnosed with IC.
    I had an uneventful pregnancy up to the point I went to L & D and was told I was 4 cm dialated and my membranes were bulging. I was put in the T-burg position in the hopes that an emergency cerclage can be placed. Unfortunately, I ended up with a fever and was told that an infection has started and so a cerclage cannot be attempted. I was told that I would remain in the hospital in this position and see what will happen. My water ended up breaking and I delivered my perfect daughter.
    I was told that with any subsequent pregnancies I would need to have a cerclage placed.

    I ended up falling pregnant again and a double McDonald TVC was placed at 12 weeks and I was put on bedrest. By 16 weeks my CL was only 1cm and by 18 weeks I had no measurable cervix with funelling. At my 20w4d appointment it was shown that my membranes had begun to descend so I was rushed in for another cerclage placement. This time a modified shirodkar was placed. Unfortunately this failed as well as my water broke 3 days later and my son was born. I was completely devastated since I had seriously thought that with the bedrest and TVC I would definitely be able to bring this baby home.

    My doctors then gave me the news that my cervix is way too short and weak for a TVC and that I will have to have a TAC placed. Thankfully, the doctor at my MFM’s office is one of the main docs here in Canada who places the TAC and I had my surgery last August. I am now 22w3d pregnant so more pregnant than I have ever been. I was still placed on bedrest and I have been on antibiotics since I found out I was pregnant and started progesterone suppositories at 16w. My cervix has stayed long and closed throughout and measures between 3.2-4.2cm!

    I am confident that with this TAC I will finally be able to bring an “earth” angel home. No woman should have to go through 1 loss yet alone multiple like I have. We need to spread the word about IC and educate others on this “silent” affliction.

  8. Stephanie Says:

    I have had 3 2nd trimester losses due to CI and was treated exactly as the article states above. After my 1st loss, I found the abbyloopers.org website and looked into the TAC however I could not get approval from Dr’s or insurance. I am now 16 weeks into my 6th pregnancy (I also had two earlier miscarriages) and had a TAC placed while pregnant at 11 weeks. The procedure overall was a much better experience than the TVC and it could possibly allow me to carry to full term without bed rest. Please advocate treatment of CI with TAC before mothers have to go through 3 painful 2nd trimester deliveries/losses! The procedure is more risky however it also has a higher success rate. I fought my insurance company for 2 months to get approval for the surgery. It is stunning to me that insurance companies would rather risk placement of a TVC and then pay NICU and/or other extensive hospital fees for the mom to be hospitalized until birth as opposed to paying for the outpatient TAC procedure which takes about 2 hours total surgery time (when pregnant) and is more successful (and prefered by the ladies who suffer from CI). Speak loudly for TAC!

  9. cassandra Says:

    Hey I read your post and I’m a mother that lost two babies the first time I got pregnant the Dr did not no why I lost my first child. All the Dr told me was my bag burst and water broke early. And I was 16 in a half weeks with my first child. I got pregnant again and I had to have the cerclage done at 15 weeks cause my Dr said my cervix was short but I still lost my baby son at 19 week he was delivered november 24 2012 and my heart my world has fell apart cause I really thought I was gonna bring this baby home.

  10. Lindsay Says:

    Cassandra, I’m so sorry for your losses. Unfortunately there are so many things that we do not yet know about the reasons for pregnancy loss. That’s why we are funding many research projects on studing possible causes for premature birth.

    We have created materials for parents who have lost a pregnancy or baby near birth. If you would like us to mail them to you, please send an email requesting them to Askus@marchofdimes.com and include your complete name and address. We will gladly send them.

    We suggest, should you wish to try again to have a baby, that you see a maternal-fetal medicine specialist (perinatologist) who specializes in high-risk pregnancies. Perhaps this specialist can offer some steps you can take to help improve your situation. Best wishes.

  11. Maidya Flowers Says:

    Hello everyone,
    To everyone who has lost a baby to IC I am so sorry for your loss. I just lost my second son a month ago due to IC. It has taken such a toll on me and my fiancé. After my first loss my OB said for me to look into a TAC but before I could arrange to get it done I found out I was 3 months pregnant with my second baby boy (don’t ask how it took 3 months for me to find out I was pregnant). This time around I’m on the Depo shot (to prevent another surprise pregnancy) and I spoke with my OB about the TAC but she was hesitant and wanted to try another regular cerclage (DO NOT EVER LET THEM PUSH YOU AROUND) I told her that there was no way I was going to risk losing another baby and if a TAC was the next best thing then that is what I was going to do. I can’t go through this anymore and I can’t go through watching my fiance watch his children being rolled away to the mourge. Spread the word about the TAC! Do the research! No one should ever have to feel this type of loss!

    May God bless you all with healthy (full term) children
    May God smile down on you
    -Maidya

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