Incompetent Cervix: Symptoms, Causes, Treatment, Prevention

Your cervix is the gateway between your vagina and your uterus. A healthy cervix helps to keep sperm in or out, protects the uterus from bacteria, facilitates menstrual blood on its way out, and is a key player in birth. 

Like any organ, sometimes things with the cervix can go awry. Some people can develop a friable cervix, cervical polyps, and cervical cancer.

As we mentioned, the cervix is a crucial part of pregnancy, labor, and birth, but sometimes conditions can arise that affect the cervix’s role in pregnancy.

An incompetent cervix, also known as “cervical insufficiency” can have a serious impact on the health of a pregnancy.

What is an Incompetent Cervix?

Although it changes slightly throughout your menstrual cycle, normally the cervix is closed and firm.

When someone becomes pregnant, the cervix slowly starts preparing for birth by softening, thinning (effacement), and dilating, or opening. 

An incompetent cervix may go through this process too soon in pregnancy, potentially resulting in premature birth or loss of pregnancy. What makes an incompetent cervix especially tricky, is that it often happens silently, or with little to no symptoms. Because of this, it is often not diagnosed until after someone has experienced a miscarriage. 

The risk of an incompetent cervix is relatively low, occurring in about one out of one hundred pregnancies. 

What Cause an Incompetent Cervix?

The cause of an incompetent cervix is unknown in most cases, however, there are some factors that can increase someone’s risk.

People who have had an incompetent cervix in previous pregnancies, those who have experienced cervical trauma like cervical surgeries, a D&C, or a cervical tear in a previous labor, as well as those with a relatively short cervix, may be at a higher risk for developing an incompetent cervix. 

The same is true for people with certain congenital conditions like uterine abnormalities, as well as those who have been exposed to diethylstilbestrol (DES) while in utero. 

There is also a rare group of inherited conditions that can cause what’s called Ehlers-Danlos Syndrome. This condition affects connective tissues that support your organs and other tissues, including the cervix. This rare defect in the protein collagen affects an estimated one in 5,000-20,000 people. Although uncommon, it can increase the risk of an incompetent cervix.

What are The Symptoms of an Incompetent Cervix?

Some pregnant people experience no symptoms of an incompetent cervix in early pregnancy. Starting between fourteen and twenty weeks of pregnancy, they may start to have mild discomfort or spotting. 

The main symptoms to look out for when watching for an incompetent cervix are:

• Changes in vaginal discharge
• Some vaginal bleeding, typically light
• Mild abdominal cramps
• Pressure in the pelvis
• New backaches

How Do You Treat an Incompetent Cervix?

Since it’s often not detected until after an early birth or miscarriage, there isn’t always treatment available for an incompetent cervix.

If you have had previous miscarriages or other risk factors for the condition, your doctor will monitor your cervix closely throughout your pregnancy. They’ll typically do this by monitoring any potential symptoms and using a transvaginal ultrasound. This kind of ultrasound involves inserting the wand into your vagina to allow your provider to see your cervix.  

Measuring the length and dilation of your cervix throughout your pregnancy can help your provider detect if you might have an incompetent cervix.

If it is detected early, there are steps your doctor can take to help prolong your pregnancy. 

If detected, your doctor may perform what’s called a “cerclage”. This procedure is done by sewing a stitch around the weakened cervix in order to make it stronger. The stitches are typically removed around thirty-seven weeks gestation. It is not done however on people who are pregnant with twins or multiples. 

While a cerclage can help someone with an incompetent cervix to have a longer pregnancy, it does come with rare, but potential risks like internal bleeding, a laceration on the cervix, infection, and sudden rupture of the uterus. 

If an incompetent cervix is not detected until later in your pregnancy, your provider will most likely recommend bed rest to help prevent you from going into early labor. 

When detected early, these treatments typically work well at preventing early birth and miscarriage. 

Can You Prevent an Incompetent Cervix?

Since the cause of an incompetent cervix isn’t quite understood, it can be difficult to determine what risk factors are. Without risk factors, it’s difficult to prevent it from happening.

Pregnancy and birth are full of unexpected surprises. While it can be stressful to think about what can go wrong during pregnancy, the best thing that you can do is support your body and baby with a nourishing diet, gentle movement that works for you, seeking prenatal care, and keeping stress levels low.