Incompetent Cervix

Diagnosis

An incompetent cervix is diagnosed only during pregnancy, and it can be challenging to confirm, especially in a first pregnancy. Your healthcare provider reviews symptoms, medical history, and past pregnancy outcomes. Sharing any history of second-trimester pregnancy loss, preterm delivery, or cervical procedures is important.

Diagnosis may involve:

• A history of painless cervical dilation and a second-trimester delivery in a past pregnancy

• Advanced cervical dilation and effacement before 24 weeks of pregnancy, with or without contractions, bleeding, infection, or ruptured membranes

Common diagnostic methods include:

Transvaginal ultrasound
A thin device called a transducer is inserted into the vagina to produce images of the cervix. It helps measure cervical length and detect any tissues bulging through the cervix.

Pelvic exam
Your doctor checks whether the amniotic sac can be felt through the cervical opening. If the sac bulges into the cervical canal or vagina, it suggests prolapsed fetal membranes and cervical opening. Contractions may also be monitored during this exam.

Lab tests
If fetal membranes are prolapsed, tests may be done to rule out infection. This can include amniocentesis to check for infection in the amniotic fluid.

There are no reliable tests before pregnancy that can predict an incompetent cervix. However, imaging like ultrasound or MRI may help identify congenital uterine issues that increase the risk.

Treatment

Managing an incompetent cervix focuses on reducing the risk of premature birth and supporting the pregnancy until the baby is further developed.

Progesterone supplementation
For pregnant individuals with a short cervix and no history of preterm birth, daily vaginal progesterone gel or suppositories may reduce the risk of early delivery.

Repeated ultrasounds
If you have a history of preterm birth or other risk factors, your doctor may monitor your cervix every two weeks from week 16 to week 24. If the cervix shortens or begins opening, a cervical cerclage may be recommended.

Cervical cerclage
This procedure involves stitching the cervix tightly closed. The stitches are removed in the last month of pregnancy or just before delivery. Cerclage may be done if:

• You are under 24 weeks pregnant

• You have a history of early births

• Ultrasound shows cervical opening or shortening

A preventive (prophylactic) cerclage may be done before 14 weeks if you have had an incompetent cervix in previous pregnancies. Cerclage is not suitable for everyone and is generally not recommended for twin or multiple pregnancies.

Pessary
A pessary is a device placed inside the vagina to help support the uterus and reduce pressure on the cervix. More research is needed to confirm its usefulness for incompetent cervix.