What is cervical insufficiency?

If you’re somewhat familiar with the female anatomy during pregnancy, you have your uterus which is carrying your baby. You have your cervix, which is the strong tissue that is supposed to be holding together a mucus plug to help block bacteria from your vagina from entering the uterus.  The cervix is supposed to remain long and closed until the end of your pregnancy. In some rare cases, as the weight of the baby increases in the second trimester, the cervix may begin to open. Cervical insufficiency / incompetent cervix is the term used for people who are unable to carry a pregnancy due to structural and/or functional defects of the cervix.

Some women may experience discharge, light to mild backpain and some women may have mild to moderate contractions or even no symptoms at all. The opening of the cervix can then lead to the amniotic sac of the baby to begin “funneling” into the vagina, which can lead to infection and/or preterm premature rupture of membranes (pPROM), where the amniotic sac ruptures. These series of events can lead to the birth of a child who has not yet reached 24 weeks, the current established age of viability in which modern medicine has the ability to attempt to prolong your baby’s survival rate. Even if the baby is born slightly past 24 weeks, the battle is still uphill for you and your baby. The baby faces a potentially long and expensive NICU stay and a life at risk of being blind, deaf, and born with cerebral palsy, etc.

Women who may be at risk for an incompetent cervix include people who are:

  • Born with cervical incompetence
  • Injury or damage done to the cervical musculature (e.g. Loop Electrosurgical Excision Procedure (LEEP) for cervical cancer, previous C-section, trauma to the cervix by procedures such as dilation and cuterrage for abortion)

There is no test that can be used to diagnose women with cervical insufficiency / incompetent cervix. Often, a woman will not know if she has cervical insufficiency/ incompetent cervix until she has reached two or more losses in the second trimester.

I fall into the category of women who have had a previous full-term pregnancy. I was in the second stage of labor and fully dilated and effaced  but had to have an emergency c-section due to my daughter’s umbilical cord being around her neck. While my cervix has not appeared to have any issues after my first pregnancy, during my pregnancy with my son, my cervix was fully open by the time he was 22 weeks gestation. I had experienced mild backpain, minimal to no-discharge and no other symptoms. I mentioned these symptoms to my provider at my 17 week appointment and she had no concerns. All of my other appointments with my OB/GYN were uneventful.

I still rack my brain thinking of what else I could have done to prevent the loss of my son. While I am not in the situation to change the outcome of my story, I know that I can pray for my angel and continue to live a life full of hope and fulfillment by being a woman of faith. I also realize that I have an opportunity to try and educate other women about this condition.

If you are a woman who has experienced any of the risk factors I have noted above, I implore you to please be an advocate yourself and talk to your provider and push for more cervical checks via transvaginal ultrasounds during your second trimester. A transvaginal ultrasound is the only accurate technique to measure the length of the cervix during pregnancy. Your OB/GYN may think you are paranoid and that the checks are unnecessary but they absolutely are not. Pushing for these extra checks can lead to early detection and a possibility to seek medical intervention such as a cerclage to try to keep your baby baking in you as long as possible.

Regular prenatal visits occur from every 4-6 weeks with the standard blood pressure and weight check, listening in on the baby’s heart rate, and measuring your abdomen to check your baby’s growth. A scan will not occur until your baby has reached 20 weeks gestation. This may be too late if you have cervical insufficiency / incompetent cervix. As mentioned previously, cervical  insufficiency is often not officially diagnosed until a woman has suffered from two or more losses. One loss is terrible enough to endure.

I want our healthcare providers to be proactive during prenatal check-ups. I want women to push for earlier detection to try to beat this terrible condition. I want nothing more than for no woman to have to face the loss of a healthy baby via an incompetent cervix ever again.

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