Cervical Incompetence

Evidence 

https://www.ncbi.nlm.nih.gov/books/NBK525954/ 

Monika Thakur; Kunal Mahajan. 

The diagnosis and management of cervical incompetence is usually managed by an obstetrician. However, the maternity and Labor and Delivery nurse should educate the patient that the non-surgical approaches of managing cervical incompetence like limiting activity, bed rest, and pelvic rest have not proven effective and their use is discouraged. Another nonsurgical treatment to be considered in patients at risk of cervical insufficiency is the vaginal pessary. The evidence is limited for a potential benefit of pessary placement in select high-risk patients. The decision to treat rests solely with the obstetrician. 

Education 

Cervical incompetence is the inability or weakness of the cervix to carry a pregnancy to term. Reaching a diagnosis can be heartbreaking for families as at times, pregnancy loss has occurred and, in some cases, multiple pregnancy losses. Cervical incompetence usually occurs in the second or third trimester of the pregnancy as more pressure and weight of the pregnancy is placed on the cervix. When a weak cervix cannot support the weight of the uterus and begins to dilate (widen) and efface (thin) before pregnancy has reached term, usually painless however cramping, spotting and a vaginal discharge may occur. 

The diagnosis of incompetent cervix is usually made in three different settings: 

1. Women who present with a sudden onset of symptoms and signs of cervical insufficiency 

1. Women who present with a history of second-trimester losses consistent with the diagnosis of cervical incompetence (history-based) 

1. Women with endovaginal ultrasound findings consistent with cervical incompetence (ultrasound diagnosis)  

Your Obstetrician will decide on the best treatment for your condition, some options include: 

• A transvaginal cervical suture placed through surgery between 12- and 14-weeks pregnancy 

• A transvaginal emergency cervical suture placed during pregnancy which has higher risks 
• Vaginal pessary 
• Transabdominal cervical suture placed prior to pregnancy through laparoscopic surgery 

Empowerment 

Being diagnosed with cervical incompetence can sometimes be a relief, especially for those that have had unexplained pregnancy loss. It can be an answer to so many questions for the parents and provide treatment options in discussion with your Obstetrician. Now with a diagnosis and a treatment plan, expecting parents, although very frightened can mostly enjoy the pregnancy more than previously. Following your health care plan can help you feel in control and more aware to any concerns if they arise allowing you to access medical attention straight away.  

Cervical Incompetence will usually place the pregnancy in the ’high risk’ category and you may have more antenatal appointments and ultrasounds than usual. If the stitch appears to be well placed further vaginal scans may not be necessary. Ultrasound can provide ongoing information to your Obstetrician for your treatment plan to be adapted as needed. A high-risk pregnancy will start many conversations about risk of premature birth and the Neonatal Intensive Care Unit or Special Care Nursery.  

Useful Links 

Pre-Term Alliance – Causes of Preterm Birth 

https://www.pretermalliance.com.au/About-Preterm-Birth/Causes-Of-Preterm-Birth 

AJGP - The shortened cervix in pregnancy: Investigation and current management recommendations for primary caregivers 

https://www1.racgp.org.au/ajgp/2019/march/the-shortened-cervix-in-pregnancy 

COPE – Centre for Perinatal Excellence  

https://www.cope.org.au/getting-help/e-cope-directory/ 

Through the Unexpected – Perinatal Diagnosis 

https://throughtheunexpected.org.au/ 

Panda - Perinatal Mental Health 

https://panda.org.au/