Incompetent Cervical Syndrome

Incompetent Cervical Syndrome

Also referred to as cervical insufficiency, this condition is thankfully uncommon but its still good to know about it . The diagnosis almost never happens in the first pregnancy until the mother miscarries. Cervical insufficiency is a sure suspect in situations where the woman has undergone a surgical procedure on the cervix or if she experiences painless bleeding few times leading to second trimester miscarriage.

What is Cervical Incompetency..

In the past doctors were not able to diagnose the situation until the mother had experienced a few miscarriages; today the problem can be diagnosed after one miscarriage


Basically the cervix opens or dilates before time without contractions.


Usually women who have had cervical surgery, incompetent cervix ensues for some of these women.


What follows is that the cervix opens much before labor begins and with no warning whatsoever.


This means the baby at this point is not mature enough to survive outside the womb but the cervix has already dilated.


The mother goes through bleeding without any painful contractions


Miscarriage become inevitable.


When a woman miscarries because of an incompetent cervix it usually happens in the second trimester.


This condition can be detected and established after early changes are recognized via vaginal ultrasound


If the mother has a history of second trimester miscarriage, her care provider may recommend that she have a Cerclage in her current pregnancy

The Causes..

Having a mother who took DES during her pregnancy (many women in the past have taken this drug to prevent miscarriages during their pregnancies)contributes to the daughter acquiring defects in her reproductive organs, which only comes under focus when she becomes pregnant herself. Fortunately the practice of taking this medication was discontinued in early 1970s.

Instances of defective reproductive organs include misshaped uterus or cervix which prevented fetuses from growing properly. Fortunately it was/is correctable.

Surgery on the cervix such as Conization, a procedure to treat cervical cancer or LEEP, a procedure to remove precancerous cells are known to cause cervical incompetence in some women

There is speculation that repeated abortions may lead to this condition as well. The logic behind this is that the cervix is manually dilated during elective abortions causing the cervix muscle to become lax over time

Sometimes the cause cannot be pinpointed to any reason. Irrespective of this, most women can go on to have a healthy pregnancy once measures have been taken to keep the cervix sealed until the time of delivery

The solution Cerclage

Cerclage will be recommended by the care provider once cervical insufficiency has been diagnosed

Several stitches are made around the cervix to keep the opening tightly closed

The mother will either be observed carefully with vaginal examinations (transvaginal ultrasounds) from week 14 to watch out for cervical changes. At the sign of the first change, the suture will be placed around the cervix.

Alternatively the suture will be placed between weeks 14 and 20 regardless of any changes

Vaginal intercourse should be avoided 1 week prior to the procedure and 1 week following it.

It is performed under anesthesia and most importantly should be done before any changes in the cervix

The success rate falls if cerclage is performed after any cervical changes such as dilation

Recovery is quick; usually it is a day surgery where you are allowed to go home on the same day

The mother may experience mild cramping and spotting which is okay; however if this continues your doctor should be informed. Medications may be prescribed to stop the pain

There are two types of cerclage: McDonald and Shirodkar

McDonald cerclage is more popular. The cerclage is temporary in that stitches are removed at full term to allow for vaginal delivery

Shirodkar cerclage used to be more complex and usually performed if the mother has had a tough time with miscarriages. The cerclage stitches were somewhat permanent and babies used to be delivered by C-section. Shirodkar cerclage has been modified since then.

Modified Shirodkar cerclage is performed if the McDonald failed previously.

Both these procedures require that the suture or stitches be removed at the start of labor or around week 38 to allow for vaginal delivery

Suture will also have to be removed if there are signs of miscarriage or premature delivery or if symptoms of infection become obvious such as fever, uterine pain or an increased heart rate in the mother or fetus