A narrow point found at the base of the uterus, the cervix dilates and opens at the end of pregnancy in cases of a normal and healthy pregnancy.

Also known as incompetent cervix, cervical insufficiency is a condition which is best described by the
premature dilation and effacing of the cervix. This normally occurs on the second until the early third trimester of pregnancy when the cervix becomes weaker and softer than normal or when the cervix begins to shorten due to the pressure exerted by the growing baby inside the uterus.

Women who have been diagnosed with this condition usually experience a premature rupture of the membranes, or in layman’s term, the water breaks before the full term. In most cases, pregnant women tend to have a preterm delivery which usually occurs before the 37th week of pregnancy. Also, it increases women’s risk for early preterm delivery which normally occurs before the 32nd week of pregnancy.

In normal circumstances, the cervix only when labour is starting at the end of pregnancy. For women with CI, the cervix opens even before the baby reaches its full term. It opens even before labour has started. Many women with CI tend to give birth without any feelings of contractions. The weakening of the cervix can result to premature delivery or miscarriage.

Most women are not aware that they have cervical insufficiency until they have premature birth or miscarriage. According to research, miscarriages due to cervical insufficiency normally occur on or after the fourth month until the seventh month of pregnancy. Furthermore, it was found out that around 25% of all miscarriages occurring after the 14thweek of pregnancy is caused by an incompetent cervix.

In most cases, CI is asymptomatic but in some cases, pregnant women tend to experience mild symptoms such as vaginal discharge, pelvic pressure, backache and pre­menstrual like cramping. Some women have noticed the feeling of ‘lump’ in their vagina and abdominal pressure is also experienced.

Through time, the consistency of the vaginal discharge tends to get thinner and its colour changes from light yellow, clear or white to tan or pink. Should contractions occur, they are normally mild. Vaginal spotting or bleeding may also be experienced. These symptoms normally occur for several days which can last up to several weeks.

When left untreated, cervical insufficiency can trigger the onset of premature pregnancy loss, like habitual abortion.

Until today, there is no clear explanation of why cervical insufficiency occurs and what exactly causes it. Researchers believe that the condition is caused by the damage on the cervix during surgeries, exposure to certain medications and injuries incurred on previous pregnancies.

The length of the cervix is also a major factor in the occurrence of incompetent cervix. According to research, women with an unusually short cervix are very likely to suffer from this condition. With cervical insufficiency, the cervix is too weak to hold on until the end of pregnancy.

Women are likely to suffer from cervical insufficiency if they have experienced the following:
If you have done a LEEP surgery on your cervix Engaged in cone biopsy

• If you had a miscarriage in the past (second trimester)
• If you had a preterm delivery in the past which was not caused by placental abruption or preterm labour
• If you have an abnormally short cervix
• If you had been diagnosed with cervical insufficiency in your previous pregnancy
• If your mother has taken the DES drug during her pregnancy.

This drug was initially made to prevent miscarriage however, it was found out later on that it causes reproductive tract abnormalities in many developing babies.

As soon as your doctor suspects that you have an incompetent cervix, he or she immediately will recommend an ultrasound scan to examine and check the thickness of your vaginal tissues.

Furthermore, if your doctor finds out that you have an unusually short cervix, she might recommend a surgery called cerclage. The procedure is done by stitching a band of strong thread around the cervix to keep it closed. However, there had been lots of controversies regarding the employment of this procedure.

According to research, cerclage can even trigger preterm delivery as well as ruptured membranes, irritation of the uterine which leads to contractions and uterine infection. Nevertheless, many women had this surgery and it was found out that its benefits are greater than the costs and risks involved. In fact, 70­90% of women who have undergone this surgical procedure have actually given birth to viable babies.

Pelvic rest is also recommended. This includes abstinence from sex, douching or tampons. Reduced physical activities and bed rest is strongly recommended to women who are very likely to have cervical insufficiency.

If you have suffered from cervical insufficiency in your previous pregnancy, you are very susceptible to suffer from the same condition on your next pregnancy. What can you do to minimize the risks involved?

Before trying to conceive, ask the advice of an expert OB­Gyne. Your doctor can provide special instructions regarding your next pregnancy and she may require frequent pre­natal checkups to monitor the length of your cervix. More often than not, doctors strongly recommend avoidance from sexual intercourse and strenuous physical activities as these may create negative impacts to your pregnancy.

If your doctor finds that your cervix is dilating even before your due date, bed rest may be advised and you may be required to undergo a cervical cerclage.