Cervical Incompetence: Causes, Symptoms, Treatment, and Cost

Cervical Incompetence is a condition in which the cervix dilates or opens too early during pregnancy, risking miscarriage or premature birth.

There are two types of Cervical Incompetence:

• Primary Cervical Incompetence: This is caused by a structural weakness of the tissue in the cervix, most commonly due to trauma from a previous dilatation and curettage (D&C). It can also occur as a result of cervical surgery or radiation treatment.
• Secondary Cervical Incompetence: This type is caused by an inflammatory response or infection within the uterus, causing the cervix to thin and become unable to retain its shape throughout pregnancy. The secretions associated with this inflammation often trigger labor prematurely

Cervical Incompetence typically occurs when the tissues of the cervix become weak and unable to hold together the uterus, leading to an increased risk of complications during pregnancy. Causes of Cervical Incompetence can include:

• Prior trauma to the cervix, such as a difficult birth or certain medical procedures like surgery, conization, and cryosurgery;
• Genetic factors
• Connective tissue disorders such as Ehlers-Danlos syndrome.

These are the symptoms of Cervical Incompetence:

• Abnormal bleeding or spotting during the second or third trimester of pregnancy.
Repeated cervical ultrasound findings such as funneling, shortening, and effacement.
• A history of prior miscarriages in the second or third trimester.
Prematurity is associated with a risk factor like structural abnormality of the cervix.
• Unexplained labor pain before 37 weeks gestation. Watery discharge from the vagina may indicate a premature rupture of membranes.

Here are some preventative steps for Cervical Incompetence:

• Use barrier methods of contraception, such as condoms or diaphragms.
• Quit smoking and limit alcohol consumption.
• Maintain a healthy weight and physical activity level.
• Seek out treatments to prevent recurrence; eg. Cervical cerclage/stitch procedure.
• Schedule regular prenatal visits and ultrasounds to monitor cervix length.
• Follow the doctor's advice when engaging in sexual activity during pregnancy.

These tests are usually done to diagnose Cervical Incompetence:

• Transvaginal ultrasound: An ultrasound probe is inserted into the vagina, which gives the doctor a view of the womb from the inside. This can be used to measure the length and width of the cervix and help reveal if it has opened prematurely. Speculum examination: A speculum is placed in the vagina, which enables doctors to visualize the cervix and determine if it has opened.
• Hysterosalpingography (HSG): This type of X-ray uses a special dye to show areas of weakness or thinning in the cervix on an image, which could indicate Cervical Incompetence.
• Biopsy: A small piece of tissue can be taken from around the opening, or os, of your cervix and tested to establish whether there is any damage or illness present that could lead to Cervical Incompetence – such as infection or inflammation from Chlamydia or gonorrhea, for example – that needs treatment before conceiving a child again.
• Hysteroscopy: This procedure involves inserting a very thin telescope through your cervix into your uterus to assess its structure - this can be done during pregnancy as well as before conception to monitor any possible issues with Cervical Incompetence throughout all stages of pregnancy.
• Corticotropin releasing hormone test (CRH): CRH test measures levels of corticotropin releasing hormone (CRH) which stimulates the production of cortisol by the pituitary gland if levels are raised then it indicates a higher chance of Cervical Incompetence.
• Urea Breath Test (UBT): UBT looks at levels of Helicobacter Pylori bacteria; this microorganism increases the risk for Cervical Incompetence.

Complications that can arise from Cervical Incompetence are:

• Premature delivery or spontaneous abortion: Cervical Incompetence can lead to the baby being born prematurely or spontaneously aborting the pregnancy due to tension in the cervix.
• Preterm rupture of membranes (PROM): Cervical Incompetence can also cause PROM, where the amniotic sac that holds the fetus breaks before 37 weeks of pregnancy.
• Premature labor: The uterus may start contracting early due to weakened cervical tissue, resulting in premature labor.
• Placental abruption: In more extreme cases, a large portion of the placenta may separate from the inner wall of the uterus unexpectedly due to cervical weakness leading to placental abruption and hemorrhage.

Here are some useful home remedies for Cervical Incompetence:

• Abhyanga: Regular massage with oils like sesame oil, ashwagandha oil, or coconut oil promotes circulation and prevents tension in the affected area.
• Asanas: Practicing yoga postures like Baddha Konasana and Parivrtta Janu Sirsasana strengthens the muscles around the neck, boosting stability.
• Pranayama: Nadi-Shodhana pranayama helps to relax tense muscles and increase blood flow in the cervical area.
• Herbs: Consuming Ashwagandha or Shatavari can boost immunity, help manage stress and reduce inflammation of tissues in the cervix.

Eating a healthy, balanced diet is important for those with Cervical Incompetence. A few suggestions are here:

• Foods rich in folate and vitamin B12, such as green leafy vegetables, can help improve blood flow to the uterus and cervix.
• Calcium-rich foods such as dairy products, beans, and grains are beneficial for maintaining good bone health and strengthening the connective tissues of the cervix.
• Foods high in omega-3 fatty acids, such as salmon, mackerel, and flaxseeds can also help to strengthen and increase elasticity in the cervical tissue.
• Eating fruits such as apples, pears, and oranges can also provide essential vitamins that may help to keep cervical tissues strong, preventing them from becoming weakened or stretched out over time.
• Iron-rich foods such as lean red meat, dark green leafy vegetables, or fortified cereals can also be beneficial for helping to prevent anemia symptoms associated with Cervical Incompetence.

These foods should be avoided in Cervical Incompetence:

• Processed foods: Processed foods such as white bread and refined grains can increase inflammation in the body, which can lead to an increased risk of developing Cervical Incompetence.
• Refined sugars: Refined sugars can also contribute to inflammatory reactions, making them an unhealthy choice for those with Cervical Incompetence.
• Trans fats: One of the worst dietary choices for Cervical Incompetence is trans fats, as they have been linked to a higher risk of developing a weakened cervix due to their inflammatory properties and role in promoting fat depositing around the abdominal area —a factor thought to weaken the cervix.
• High sodium/salt content: Eating a diet high in salt is not beneficial for those with Cervical Incompetence and may worsen it, as elevated levels of sodium are associated with an increased risk of uterine contraction.
• Alcohol: Excessive alcohol consumption can affect the production of hormones related to pregnancy, and should be avoided by those suffering from Cervical Incompetence due to its potential consequences on fetal development and health outcomes.

Treatment for Cervical Incompetence may include:

• Medications: Treatment typically involves medications to help strengthen and support the cervix, such as progesterone or a progestin-releasing intrauterine device (IUD).
• Bed rest: Resting at home or the hospital as prescribed by your healthcare provider to improve uterine and cervical health, promote healing and reduce the risk of preterm delivery.
• Monitoring Fetal Movements: Close monitoring of fetal movements is also important for women suspected of Cervical Incompetence to alert their healthcare provider if there are any signs/symptoms indicative of preterm labor/delivery.
• Cerclage: A surgical procedure in which the part of the cervix that is weaker or thinner than normal is sewn closed to keep the baby inside the uterus.
• Cervical stitch (Shirodkar): An incision is made in the cervix and a suture is used to keep it closed over time.
• Cone biopsy: A cone-shaped piece of tissue from the cervix is removed and replaced with a synthetic plug to close off the opening of the uterus
• Transabdominal cervical cerclage (TAC): Instead of placing a suture around the cervix, this procedure uses mesh or stitches placed directly into cervical tissues from an abdominal incision.

If you are experiencing symptoms of Cervical Incompetence or have been advised by your doctor for testing for it, then the best doctor to consult would be an obstetrician or a high-risk pregnancy specialist.
• Obstetrician: An obstetrician is specially trained to identify and care for women with Cervical Incompetence during pregnancy, diagnosis, and management of labor, and management of complications associated with preterm delivery.
• High-risk pregnancy specialist: A high-risk pregnancy specialist would similarly provide medical expertise to manage the problem and can recommend appropriate treatment options depending upon each case’s requirements.

These are commonly suggested medicines for Cervical Incompetence:

• Progesterone: Progesterone is a hormone that helps prepare the uterus for pregnancy and maintain pregnancy. Examples include progestins (brand names such as Cyclogest, Utrogestan, and Crinone) as tablets, injections, gels, or vaginal insert pessaries.
• Antispasmodics: These drugs help to relax the muscle of the cervix to prevent preterm delivery. Examples include tolterodine (brand name Detrol) and oxytocin (brand names Pitocin and Syntocinon).
• Anti-inflammatory Drugs: These drugs are used to treat inflammation of the uterine cervix that may lead to premature labor. Examples include nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Advil), naproxen(Aleve), indomethacin (Indocin), and etoposide(Etopophos).
• Antibiotics: These medications are used to help fight infection in cases where Cervical Incompetence has been caused by an infection such as bacterial vaginosis or chlamydia. Examples include tetracyclines such as doxycycline and amoxicillin/clavulanic acid (Augmentin).

The recovery time after being diagnosed with Cervical Incompetence varies based on the severity of the case and the treatment used.
Generally, the healing process takes four to six weeks, with some women taking longer to fully recover. During this period, doctor-prescribed bed rest and medications may be necessary to promote healing and protect against preterm labor or miscarriage.

The results of treatment for Cervical Incompetence vary depending on the method used.

• Generally, patients who undergo a cervical cerclage may experience temporary success, but many eventually require repeat cerclage procedures and can develop Cervical Incompetence again.
• Patients who undergo a commercial cone biopsy or modified radical hysterectomy may experience more permanent results. However, these procedures are considered major surgeries and are often only recommended as a last resort if other methods have failed.

These are commonly suggested medicines for Cervical Incompetence:

• Progesterone: Progesterone is a hormone that helps prepare the uterus for pregnancy and maintain pregnancy. Examples include progestins (brand names such as Cyclogest, Utrogestan, and Crinone) as tablets, injections, gels, or vaginal insert pessaries.
• Antispasmodics: These drugs help to relax the muscle of the cervix to prevent preterm delivery. Examples include tolterodine (brand name Detrol) and oxytocin (brand names Pitocin and Syntocinon).
• Anti-inflammatory Drugs: These drugs are used to treat inflammation of the uterine cervix that may lead to premature labor. Examples include nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Advil), naproxen(Aleve), indomethacin (Indocin), and etoposide(Etopophos).
• Antibiotics: These medications are used to help fight infection in cases where Cervical Incompetence has been caused by an infection such as bacterial vaginosis or chlamydia. Examples include tetracyclines such as doxycycline and amoxicillin/clavulanic acid (Augmentin).

The cost of Cervical Incompetence treatments in India varies depending on the type of treatment and hospital chosen. Generally, it can range from around Rs.30,000 to Rs.1 lakh or more. Follow-up visits and ultrasounds may be required as well, which will further increase the cost.

Potential side effects of treatments for Cervical Incompetence are given here:

• Many Cervical Incompetence treatments involve surgery to help support the cervix, such as a cerclage or cervical stenting. This can result in side effects such as pain, fever, and infection at the surgical site.
• Hormone treatments such as progesterone injections can also be used to support the cervix but may cause side effects of headaches and allergic reactions.
• Bed rest or other activity restrictions may be recommended as part of treatment, leading to further risks such as the increased risk of blood clots or decreased bone density or muscle mass.
• In extreme cases, a hysterectomy may be necessary which carries potential risks of bleeding and infection associated with any major surgical procedure.