Incompetent Cervix

By:  Dr. Umesh N Jindal On:  June 1, 2016 8:52 AM
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It is a weakness of the cervix i.e. the opening of the uterus, which leads to abortion of the fetus at 3 to 6 months of gestation. It is characterized by sudden painless opening of the cervix, breaking of waters and expulsion of the immature fetus. Unless effectively treated, this sequence tends to repeat in every pregnancy.

Cause:

Previous trauma to the cervix as in D & C (dilatation & curettage), abortions, cauterization.
In many cases there is inherent weakness of the cervix, probably due to abnormal development. Symptoms usually develop in the second trimester i.e. at 3-5 months of gestation. There may be a feeling of heaviness in the lower abdomen along with sudden passage of a gush of fluid or breaking of waters. This is followed by intermittent pain abdomen and expulsion of the fetus.

Diagnosis:

Usually the diagnosis is made by the typical history of single or repeated mid-trimester abortions in the patient. In the non-pregnant patient it can be diagnosed by the presence of a loose, painless cervix on examination.
Sometimes, the x-ray of uterus and tubes done for evaluation of infertile patients reveals an incompetent cervix.
During pregnancy, most important tool for diagnosis is the trans-vaginal USG which shows signs of a short or loose cervix and opening of the cervix.

Treatment:

Is required in all cases. It involves a short surgical procedure called cervical encirclage done under anesthesia, where a stitch is applied to the cervix in order to provide support and prevent its opening. This surgery is done at 14 – 24 weeks of pregnancy and is contraindicated in the presence of bleeding, sever pain, rupture of membranes or infection in the uterus. If the symptoms of incompetence develop after 24 – 26 weeks, the patient has to be put on strict bed rest. After cervical encirclage the patient needs to have bed rest and regular follow up with the doctor. The stitch has to be removed after completion of 8 months or earlier if labour pains start.

Prevention:

  • Any patient with history of abortions should consult a gynaecologist for a thorough check up and investigations.
  • In pregnant patients regular follow up and weekly ultrasound examinations can help in early diagnosis and preventive cervical encirclage can be done.
  • Local hygiene and prompt treatment of any infections in the genital or urinary tract should be done.
  • Avoidance of intercourse and bed rest also helps.