Cervical Incompetence

Did you know that up to 20% of second trimester miscarriages are due to incompetent cervix? In an unaffected woman, the cervix (neck of the womb) is strong enough to hold the womb closed and prevent any pre-term contractions from occuring, as well as taking the expanding weight of the pregnancy.

In a small number of women, the cervix is weakened and begins to dilate, causing blood loss, pain and sometimes premature labour. Most babies are lost at around 16-24 weeks gestation, where survival is not possible.

The condition usually re-occurs in subsequent pregnancies, so women with incompetent cervix can struggle for months or years to attain a family.

Who Is At Risk Of Incompetent Cervix?

The following groups of women may have a higher risk of incompetent cervix:

• Women with an abnormally shaped womb and cervix
• Those who have had treatment for cervical cancer or other cervical abnormalities
• Those with previous pelvic inflammatory disease, where the cervix is scarred
• Anyone who has had a D+C (dilation and curettage) for a miscarriage, infection or termination
• Anyone who has had several terminations of pregnancy, or damage to the cervix through termination
• Anyone who has had cervical damage during a previous childbirth
• Anyone who has suffered a previous second trimester miscarriage
• Those with previous vaginosis infection.

How Can I Reduce My Risk?

If you have any vaginal discomfort, burning or bleeding, get any suspected infection treated immediately, as some infections can cause damage to the cervix.

If you have a miscarriage, consider NOT having it medically managed. Most early miscarriages occur without adverse after-events and in most cases the body naturally expells products of conception without needing any assistance. D+C's are invasive, can cause infection and cervical weakness, and in rare cases, perforation of the womb, which can be life-threatening. Therefore, they should only be done where there is a clear medical need (i.e. an incomplete abortion where tissue remains in the body).

If you have had a second trimester miscarriage in the past, you can ask for further investigations to diagnose the condition, such as a transvaginal ultrasound scan, so that doctors may manage the condition to maximise your chances of having a baby.

What Treatments Are Available?

Suturing the cervix is the standard treatment for this condition. This is called a cervical cerclage. Stitches will be put in to your cervix to hold it closed. You will have a spinal anesthetic during this procedure as the bladder also has to be moved out of the way in order for the stitches to be put in the correct place.

These stitches are then removed at 37 weeks gestation to allow you to go into labour and have a vaginal birth.

Another more radical option is a transabdominal cervical cerclage. This is where an abdominal incision is made, similar to a caesarean section, and stitches are placed in the cervix via that route. This method has a greater success rate than a normal cerclage and can be left in for subsequent pregnancies but it is major surgery for the woman and it means that she will have to deliver by caesarean section as it makes vaginal birth impossible.

Both these procedures carry a small risk of miscarriage, but the risk of incompetent cervix is usually greater and it can be some women's only chance of having a baby.

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