Understanding cervical incompetence
By Dr Devika Gunasheela
13th February 2013 08:29 AM
Cervical incompetence is a medical condition in which the neck of the womb (cervix) in a pregnant woman begins to open and thin out much before the date that the baby is due to be born.
Cervical incompetence may cause miscarriage or preterm birth during the second and third parts of the pregnancy.
In a woman with cervical incompetence, the opening (dilation) and thinning (effacement) of the cervix may occur without pain or uterine contractions.
In a normal pregnancy, these occur in response to uterine contractions.
Cervical incompetence occurs because of weakness of the cervix, which is made to open by the growing pressure in the uterus as pregnancy progresses and the fetus gains weight.
If this process is not halted, the bag of waters around the baby may burst and can result in birth of a premature baby.
According to statistics provided by the Mayo Clinic, cervical incompetence occurs in only 1 - 2 per cent of all pregnancies, but it is thought to cause as many as 20 - 25 per cent of miscarriages in the second trimester.
What are the risk factors for the cervix to open up suddenly?
* Risk factors for cervical incompetence include _ History of previous pregnancies ending in abortions in the second and early third trimester (i.e., between 13 - 30 weeks of pregnancy).
* Any operations on the neck of the womb.
* Repeated abortions where the pregnancy has taken out surgically.
* Any significant trauma to the cervix which can weaken the tissues involved
How is it diagnosed? _ A good medical history of previous abortions in the mid pregnancy will provide a clue.
Ultrasound scans in pregnancy can also provide valuable information regarding the length of the cervix and also whether it is opening up at the top end.
* In a non-pregnancy state, the tightness of the cervical opening can be assessed by passing large sized dilators without resistance.
How do you treat? Treatment of Cervical Incompetence:
* Once the problem of incompetence is diagnosed, the condition may be treatable through a surgical procedure called cerclage (stitching the cervix closed). One or more stitches are placed around or through the cervix to keep it tightly closed.
* This is usually performed after the twelfth week of pregnancy, the time after which a woman is least likely to miscarry for other reasons - but it is not done if there is rupture of the membranes or infection.
* After surgery, the mother is carefully monitored to check for infection and contractions, which are sometimes brought on by the procedure. There is no need for bed rest, but in special cases like the one cited below.
In this case, the patient had repeated miscarriages in the middle of the pregnancy despite the suture applied.
One can apply a trans-abdominal approach where the stitch is applied at a higher level through a laparoscopic procedure with a tape is called as Trans-abdominal Cervical Cerclage.
This gives more security to the pregnancy than a trans-vaginal approach which is the one most often used.
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