What You Should Know About Cervical Incompetence

Whether this is your first pregnancy or you’re adding to your growing family, you want to make sure that everything goes as smoothly as possible. When a condition like cervical incompetence develops, which often does so without warning, the consequences can be devastating. Thankfully, this condition isn’t common, but it’s still beneficial for you to learn as much as you can about your potential risks.

To help, our team of high-risk obstetric specialists at the Women's Clinic of the Rio Grande Valley, led by Dr. Fernando Otero, pulled together the following information on cervical incompetence.

Cervical incompetence at a glance

During a normal pregnancy, your cervix, which is the lower part of your uterus that connects to your vagina, remains firmly shut. As you approach your delivery, your cervix begins to relax, shorten, and ultimately dilate in order to allow your baby to pass through.

With cervical incompetence, which is also called cervical insufficiency, your cervix begins to relax and dilate too soon, which can result in giving birth too early, usually in the second trimester. 

Unfortunately, this can occur without warning and for no known reason, but it doesn’t happen very often — the incidence rate is 0.5% in the general obstetric population and 8% in women with a history of previous midtrimester miscarriages.

While it’s difficult to predict whether you may develop cervical incompetence, there are a few factors that may place you more at risk, including:

• Cervical trauma due to previous surgeries or procedures
• Race, as Black women are more at risk of developing cervical incompetence
• Structural abnormalities in your uterus
• An unusually short cervix
• Uterus damage from a previous birth or miscarraige
• Exposure to diethylstilbestrol, a synthetic form of estrogen 

Again, we underscore the point that cervical insufficiency often develops outside of these risk factors. And having the risk factors we outline above doesn’t mean you will develop cervical incompetence, but your risk is elevated.

Recognizing the signs (if they appear)

One of the more alarming aspects of cervical incompetence is that it can often develop without any warning. That said, there are a few signs that you should be on the lookout for, including:

• A pressure in your pelvis
• Mild abdominal cramps
• Lower backache
• New vaginal discharge
• Spotting

We understand that these symptoms are often part and parcel of a normal pregnancy, so we urge you to recognize when there’s a change in these symptoms, which could indicate a developing problem.

Addressing cervical incompetence

If you have any of the risk factors we outline above or you’re experiencing any unusual symptoms, our first step is to perform a transvaginal ultrasound.

If we find that there’s a problem, our treatment approach depends upon where you are in your pregnancy. Sometimes, frequent ultrasounds to monitor your pregnancy is all you need.

If the problem is more imminent, we may recommend a cervical cerclage, a procedure in which your uterus is sutured shut. The American College of Obstetricians and Gynecologists issued guidelines for cervical cerclage for women in their second trimester who are carrying only one child. 

These guidelines recommend cervical cerclage if you:

• Had a previous second-trimester pregnancy loss associated with painless cervical dilation without labor or placental abruption
• Had a cerclage in a previous pregnancy because of painless dilation
• Have painless cervical dilation now
• Have a history of spontaneous preterm birth before 34 weeks, and you currently have a cervical length under 25 mm before 24 weeks

To determine whether you’re a candidate for a cervical cerclage, we thoroughly review your medical history as well as your current situation and make an appropriate recommendation.

If you have more questions about cervical incompetence, please feel free to contact one of our two offices in McAllen or Edinburg, Texas.