Cervical insufficiency must be detected and treated as early as possible. Shortening of the cervix before the expected delivery date poses a serious risk to the pregnancy.
Here you can find out everything about cervical insufficiency and what treatments are available for it.
Table of contents
What Is Cervical Insufficiency?
The cervix is the neck of the uterus. During pregnancy, the cervix and the cervical canal have the task of keeping the uterus closed until the expected date of birth.
In pregnancies that are unremarkable, the length of the cervix is about three centimeters, with the cervix firmly closed. However, if you have cervical insufficiency, your cervix may begin to open as early as the 15th week of pregnancy.
If you have cervical insufficiency, your body can no longer close the cervix. In this case, the cervix opens before the expected delivery date. In cervical insufficiency, the cervix is shorter than the usual three centimeters. The cervical canal itself is also soft.
Difference From Preterm Labor
The cervix can be between two and three centimeters wide in cervical insufficiency as early as the second trimester. The major difference between timely cervical shortening and shortening at the cervix is that cervical insufficiency occurs without labor.
Most often, cervical insufficiency occurs between the fourth and sixth months of pregnancy. During this time, your baby is viable only with the greatest complications and may suffer permanent damage if born prematurely. For these reasons, it is so important to detect and treat cervical insufficiency as early as possible.
What Are The Causes Behind Cervical Insufficiency?
With all the complex processes your body has to deal with during pregnancy, the causes of cervical insufficiency are also very different. It is not uncommon for the cervix to be shortened when several of these factors combine.
During pregnancy, your body is busy housing and developing your baby. Your immune system is therefore somewhat weaker than usual, which favors the occurrence of infectious diseases. Therefore, it is not only likely that you will catch a cold during your pregnancy.
Other infections, such as bacterial vaginitis or a fungal infection, are also more likely during pregnancy for this reason. These infections can be responsible for cervical insufficiency.
This is because the germs eventually rise to the cervix and release inflammatory messengers there. These then ensure directly on-site that the cervix reacts by shortening. This is why it is so important during pregnancy to have inflammations and infections treated as quickly and reliably as possible.
Chlamydia and gonococcal infections are particularly dangerous, but so is an infection with Garnerella vaginalis.
If you have already had one or more surgeries on the cervix, cervical insufficiency during pregnancy is more likely than in other expectant mothers.
For example, if you have had conization of the cervix, it will need to be looked at very closely as part of your check-ups. The risk of cervical insufficiency is particularly high in the case of very deep or particularly extensive conizations.
If you are expecting more than one baby, the joy of pregnancy is at least twice as great. Still, a twin or even triplet pregnancy can be a clear risk factor for cervical insufficiency developing during the course of the pregnancy.
Where in a singleton pregnancy only the single weight has to be held by the cervix, the expected pressure in multiple pregnancies is twice as great. The resulting stress can easily put too much strain on the cervix. This is why it is monitored very closely in multiple pregnancies.
Other Reasons For Cervical Insufficiency
In addition to infections or multiple pregnancies, there may be other reasons for a weak cervix. For example, if you have already had a miscarriage or premature birth, your risk of cervical insufficiency is increased.
Also, if you have already suffered from cervical weakness in a previous pregnancy, this is also likely in subsequent pregnancies. It is then very likely that connective tissue weakness is behind it.
So if you already know that you suffer from connective tissue weakness, you should talk to your doctor about it during your first check-ups. Your cervix should also be closely monitored if you tend to bleed during pregnancy.
In addition to numerous other pregnancy complications, smoking can also lead to cervical insufficiency, as the harmful substances hinder normal connective tissue activity.
How Do You Notice Cervical Insufficiency?
Regardless of the severity of cervical insufficiency, the symptoms you may experience also vary greatly. Some women don’t feel anything at all from the prematurely dilating cervix.
Others complain of uncomfortable pain that is most comparable to period pain. Still, others report pressure or pulling near the pubic bone. Some expectant mothers also describe pulling pains in the groin area or on the back.
However, it is still not possible to diagnose cervical insufficiency on the basis of the symptoms described here. This is because the symptoms described are not substantially different from preterm labor or even exercise contra ctions during pregnancy.
Very often, cervical insufficiency is not recognized until a pregnant woman has already had preterm labor or miscarriage. That is why it is so important to react and present to the doctor or hospital even if you suspect it.
Suspicion Of Cervical Insufficiency? Go To The Doctor!
If you suspect that you are suffering from cervical insufficiency, you should immediately make an appointment with your gynecologist or visit the doctor’s office at short notice. He or she can quickly and accurately determine whether you have this problem.
In most cases, a vaginal ultrasound examination is performed, during which the length of the cervix is measured. At the same time, the ultrasound image also shows whether the cervix is already open and, if this is the case, how wide it is.
If actual cervical insufficiency is detected, there is a high risk of premature birth. Depending on the situation, immediate further treatment in the hospital may then be indicated.
These Therapies Are Available For Cervical Insufficiency
Cervical insufficiency does not have to mean that you will become the mother of an extremely premature baby in the next few hours. Today, there are many therapies available to delay the birth as much as possible or even to close the cervix completely again.
Bed Rest And Tocolysis In The Hospital
Is your cervix shortened and the cervix possibly already open? Then you will probably be admitted to the hospital immediately and have to stay there on strict bed rest. Physical exertion is now absolutely taboo. You should avoid passive smoking at all costs, as this puts your body under even more stress.
If you are before the 34th week of pregnancy and are already experiencing mild contractions in addition to cervical insufficiency, tocolysis will most likely be performed in the hospital.
During this procedure, you will be administered labor-inhibiting medications that are intended to slow down the uterine muscles. The tocolytics will be administered intravenously under bed rest. A CTG will be taken at short intervals to monitor the effect of the tocolysis on your body, but also on your baby.
It is not uncommon for an undetected infection to be behind cervical insufficiency. In this case, the pathogen is first identified in the hospital and then appropriate antibiotics are started immediately. On the basis of the blood values, which are closely monitored, a decision can then be made on how to proceed with treatment.
This is also always dependent on the week of pregnancy in which you are already.
Cerclage: Surgical Closure Of The Cervix
If you are already diagnosed with cervical insufficiency in the first or second trimester of your pregnancy, a cerclage may be the method of choice to ensure a healthy pregnancy on schedule.
It is usually placed when the cervix is at least two and a half centimeters wide open. It is the artificial closure of the opened cervix.
This is a plastic band that is placed around the cervix. This is to support the cervix and keep it closed. Another way to perform this procedure is to sew the cervix with a thread.
This cervical closure is absolutely complete and is very often used to prevent ascending infections from entering the uterus
If the amniotic sac has already fallen through the opened cervix into the vagina, a so-called emergency cerclage can be performed. Surgical closure can be performed as early as the fourth month of pregnancy.
If you have multiple pregnancies, surgical closure may be indicated as early as between the 12th and 14th week of pregnancy. Only in the hospital and under anesthesia is it possible to suture the cervix appropriately.
How Long Does The Cerclage Stay In Place?
The cerclage then remains in place on the cervix up to two weeks before the expected delivery date. Usually, this procedure is not performed after the 24th week of pregnancy. Then the risk is too great to injure the amniotic sac or to cause a premature birth through the operation.
Existing infections or unexplained bleeding are also considered contraindications for surgical closure of the cervix.
In addition to closing the cervix with a suture, there is now also the cerclage pessary. This is a soft rubber ring that is pulled over the cervix. The pessary can be inserted without anesthesia.
What Happens After The Cerclage?
Closure is a very minor, routine procedure that should not cause you undue stress. In fact, you should still recover well from the anesthesia. As soon as you are discharged from the hospital, however, you should take it easy. Depending on your profession, it may be necessary for you to be prohibited from working.
Mild spotting and cramps are common immediately after the operation, which may also cause pain when urinating. If these symptoms persist for several days or change to severe pain or contractions, you must see a doctor immediately. After surgery, your doctor will probably advise you to abstain from sexual intercourse until birth.
Removal Just Before ET
You have almost reached the expected date of birth? If so, the cerclage will be removed again, which usually happens one to two weeks before the due date. Vaginal delivery is still possible. The removal is performed under local anesthesia, which may already trigger labor pains in some women, but by no means must.
After a cerclage, a prolonged opening phase is usually observed during labor because the cervix is less stretchable due to the tight closure.
Can Cervical Insufficiency Be Prevented?
If you have already suffered from cervical insufficiency during a previous pregnancy, your risk of developing cervical insufficiency again is significantly increased. To date, there is no absolutely reliable prevention of cervical insufficiency.
However, it is possible to minimize risk factors. This includes, for example, completely abstaining from nicotine. If possible, overweight or underweight should be under control before pregnancy.
Especially if you are under a lot of pressure at work or are involved in particularly stressful, physically demanding activities, you can apply for a ban on employment during pregnancy.