Most mothers are anxious to meet their unborn babies. The sooner the better, right? Not exactly. When it comes to birth, there is such a thing as “too soon”! An incompetent cervix can cause a baby to arrive too soon. And that’s far from a good thing. It can lead to birth injuries.
Follow along to find out what causes this pregnancy complication, and why it’s so important to catch and treat it right away.
Incompetent Cervix Explained
“Incompetent” sounds like a word describing an employee failing at their job, doesn’t it? That’s close to what happens with this medical condition. The cervix plays an important part in pregnancy and delivery. When it fails to “do its job”, complications and injuries can result.
Other names for this condition are:
- Cervical insufficiency
- Insufficient cervix
What exactly does the cervix do? This small, narrow passage at the bottom of the uterus connects the uterus to the vagina. The uterus is where the baby grows. So you might think of it like a gatekeeper separating the baby from the outside world.
The main job of the cervix is to protect the uterus. It has a thick, muscular wall that helps keep the uterus closed most of the time. So the cervix helps keep the baby safe inside.
During childbirth, the cervix undergoes changes. It starts to open wider, allowing the baby to pass through the birth canal. This process is called dilation.
For women with incompetent cervix, the dilation process may start too early. This can cause a miscarriage or premature birth.
Signs and Symptoms
Some women with incompetent cervix have no symptoms at all. Others have mild symptoms like abdominal cramps. Most of the signs will show up between 14 and 20 weeks of gestation. They include:
- Pain or pressure in the pelvic area
- Vaginal mucus/discharge changes
- Backache
- Light spotting or bleeding
- A sensation that “something is coming out” (Feeling like something is descending from the vagina. This means the cervix could be opening up too soon).
- Braxton-Hicks-like contractions
- Preterm labor (Going into labor before the 37th week of pregnancy).
The signs and symptoms of insufficient cervix above aren’t exclusive to it. They can also pertain to other pregnancy complications. So doctors can’t diagnose this condition based on symptoms alone. This is why it’s very important to discuss all symptoms with a doctor and undergo appropriate testing so you can arrive at the correct diagnosis.
Diagnosing Insufficient Cervix
There are generally three “boxes” doctors need to check when diagnosing cervical insufficiency. They need to consider the patient’s history, perform a physical exam, and order appropriate studies.
Let’s go into more detail about the diagnosing process:
- Patient history: A patient’s past can provide early “warning signs”. If the patient had problems with their cervix in the past, they may have the same problems again. Doctors should ask if the patient has had any miscarriages and premature births.
- Physical exam: During the second or third trimester, doctors can perform a pelvic exam to check for insufficient cervix. They will look for two things: dilation and effacement. Dilation means the cervix has begun to open. Effacement means the vaginal part of the cervix has started thinning and shortening.
- Testing: Physicians should order transvaginal ultrasounds for women who might have cervical insufficiency. These ultrasounds can reveal any issues.
Treatment for Incompetent Cervix
The main goal when treating incompetent cervix is keeping the baby in the womb until it’s the right time for birth. There are two main ways to do this: progesterone regimen, and cervical cerclage.
Progesterone Treatment
Progesterone is a pregnancy hormone. It helps to maintain the integrity and stability of the cervical tissue. Taking additional progesterone can help prevent contractions from happening before the baby is ready to leave the womb. A doctor might prescribe progesterone pills or injections to reduce the risk of premature birth.
Cervical Cerclage
A cervical cerclage is a procedure that involves stitching the cervix closed. It provides support and keeps the “door” shut so the baby stays safe inside the womb. This is very effective for preventing preterm birth.
When do women undergo this procedure? Doctors usually perform a cerclage during the early part of pregnancy. Then they remove it near the end when the baby is ready to be born. But the exact time depends on the specifics of a woman’s pregnancy.
One study found that the effect of elective operation at 14 to 18 weeks of pregnancy was more ideal than waiting longer. Women with a history of cervical insufficiency might need to undergo this procedure around 14 weeks or possibly even before. One study found that Sometimes doctors might order an emergency cerclage in the third trimester to prevent preterm birth.
Who should get a cervical cerclage? Doctors might recommend a cerclage for a woman who has had incompetent cervix or preterm deliveries in the past. It’s not recommended for women who have an infection, placental abruption, or preterm premature rupture of membranes (PPROM).
Cerclage is a safe, uncomplicated procedure. Women often go home a few hours after having it done. But it doesn’t come without a few risks. Potential complications include:
- Infection
- Cervical lacerations
- Bladder or uterine rupture
- Preterm labor
- Premature membrane rupture
- Maternal bleeding
After a cerclage, doctors have the obligation to monitor women for signs of complications. If there are no signs of complications, the woman can leave the hospital. Most doctors recommend staying inactive for a few days so that the suture site can heal.
What Causes Incompetent Cervix?
The most common cause of incompetent cervix is structural weakness. In other words, the cervix is too weak to withstand the baby’s weight. There are two reasons why this might be the case. The first is that it could be inherently weak because of structural abnormalities. The second is that it has suffered some sort of trauma or injury in the past.
Here are some of the factors that contribute to cervical weakness:
- Hormonal factors. For example, a woman might have insufficient progesterone.
- Uterine Abnormalities. Conditions like uterine fibroids or a septate uterus can affect the shape or structure of the uterus. They can put pressure on the cervix and weaken it.
- Previous Cervical Procedures. Repeated dilations or surgeries can weaken the cervix over time.
- Trauma or Injury. In rare cases, trauma or injury to the cervix during pregnancy or prior to pregnancy can lead to cervical insufficiency.
Also, certain factors can make a woman more likely to have cervical insufficiency. These include:
- Having short cervical length
- Previous miscarriage
- Previous preterm delivery
- Having repeated abortions or a late-term abortion
- Having twins or multiples
- Exposure to diethylstilbestrol (DES), or synthetic estrogen
Incompetent Cervix Lawsuits
Can you sue a doctor for malpractice when they mishandle cervical insufficiency? It’s possible! We have seen cases where the defendants failed to offer cervical cerclage when they should have. As a result, the babies were born prematurely and had birth injuries.
If your doctor was negligent while treating you, you may have grounds to sue. But three things must be true:
- You still have time to sue (the statute of limitations in your state hasn’t passed yet).
- Your doctor’s actions fit the legal definition of negligence.
- The doctor’s negligence harmed you or your child.
It can be difficult to know whether your case is viable. That’s where we come in. We invite you to contact our birth injury lawyers here. Should your case be viable and we agree to work together, we’ll put our expertise towards getting you the financial compensation you deserve.
