It can be heartbreaking to get a diagnosis of Incompetent Cervix. Many women experience guilt and frustration because, there are no known causes of IC. In many cases Incompetent Cervix is diagnosed too late, as the signs of an insufficient cervix are not visible. The cervix becomes weak and either opens gradually, or spontaneously, resulting in premature labor. In extreme cases Incompetent cervix can lead to pregnancy loss. While a definite cause is not known, there are a few factors that can contribute to Incompetent Cervix, and you should talk to your doctor about them. It is important to inform your doctor of your pregnancy and gynecological history so that a decision to treat for Incompetent Cervix can be made.
Some factors that may contribute to this condition are DES exposure, cervical trauma, a short cervix, D&C and uterine abnormalities. If you have suffered a previous pregnancy loss after, 12 weeks, inform your doctor. If you have every had a cone biopsy, LEEP procedure, or a D&C, or abortion you are at higher risk for incompetent cervix.
Incompetent Cervix is diagnosed when a woman has had prior losses during the second trimester of a pregnancy. A cervix should remain closed during a pregnancy until labor begins. In patients with Incompetent Cervix the cervix begins to open, often without any signs, after the 13th week of pregnancy. The membranes surrounding the baby will bulge into the cervix until the waters eventually break resulting in preterm labor. Spontaneous loss due to incompetent cervix accounts for 20%-25% of all second trimester losses. A loss due to Incompetent Cervix is different than a miscarriage which happens within the first 3 months (12 weeks) of pregnancy.
A woman can show signs of Incompetent Cervix even when the pregnancy did not result in a loss. Spontaneous opening or dilation of the cervix, without contractions, are a good indication that the condition is present. Infections found in the amniotic fluid can be a sign of Incompetent Cervix, and suggests that the cervix was open, and allowed bacteria to pass through to the uterus. Every woman and every pregnancy is different! If you have had preterm labor or other complications you should discuss Incompetent Cervix with your doctor.
If Incompetent Cervix is diagnosed early in pregnancy a doctor will recommend a cervical cerclage. A cervical cerclage is a suture placed around the cervix to prevent the cervix from opening. A cervical cerclage is similar to a purse string as it is drawn in a way to close the cervix completely. In some cases a cerclage is removed, around 36 weeks, to allow labor to progress naturally. If the cerclage is not removed then a pregnant woman will have a caesarean section. If the cerclage procedure is done before the 16th week of pregnancy it is most effective. In some cases an emergency cerclage can be placed later in pregnancy if the cervix has opened or shortened. Cervical cerclage is effective in preventing preterm labor in 85%-90% of cases.
A cerclage can only be placed when a women meets certain criteria. The membranes must still be intact, the baby must be alive and you cannot be more than 4 centimeters dilated. If you are showing signs of hyper-irritability of the cervix your doctor may choose to treat with medication therapy until the chances for a successful cerclage placement improve.
In cases where Incompetent Cervix is diagnosed later in a pregnancy an emergent cerclage may be placed. This procedure involves more risk and is normally followed by bedrest in the Trendelenburg position. Medication will be given to treat for infection and to stop contractions. The Trendelenburg position is used to allow gravity to pull the baby and membranes away from the cervix.
Incompetent Cervix can present symptoms on its own or with another underlying condition. You may even experience symptoms of IC paired with another condition altogether. Your doctor may send you home with medication to prevent further complications, or keep you in the hospital on medication and constant monitoring of your condition. You may require magnesium sulfate therapy to prevent contractions. You may be given steroid injections to improve the babies chances of survival in severe cases.
The severity of Incompetent Cervix is varied and requires different treatment. In cases where the membranes have ruptured, or your cervix has dilated substantially a cervical cerclage cannot be placed. In conditions such as this the Trendelenburg therapy and medication will be used to prolong pregnancy until doctors can be sure the baby has a good chance of survival.
In cases where Incompetent Cervix is discovered early many women can receive treatment and resume most normal activities. Restrictions will be placed on what can be lifted and when you need to rest. Follow ALL of your doctors instructions. Consider light duty work as an alternative to your normal working conditions .Rest with your legs elevated as much as possible. DON'T resume intercourse or sitting in bath water unless you get an okay from your doctor. Severe bleeding isn't associated with Incompetent Cervix and you should seek medical attention immediately.