Posts Tagged ‘uteine defects’

What is cervical insufficiency?

Monday, August 16th, 2010

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.