Last updated September 2011. Planned review date: September 2013
Problems with the cervix (incompetent cervix/cervical weakness/cervical insufficiency)
Cervical weakness/an incompetent cervix/cervical insufficiency are all terms used for cervical causes of premature labour. Essentially what it means is that the cervix can begin to dilate and shorten before the pregnancy reaches full term. This can lead to the waters breaking and the baby to be born prematurely.
The cervix is the small canal at the base of the uterus that connects it to the vagina - known as the neck of the womb.
The cervix beginning to dilate and shorten can also be a sign of early labour for other reasons so it can be hard for the healthcare team to tell the difference between a weak cervix and early labour.
Cervical causes of premature labour
An existing cervical weakness may have been caused by problems with an earlier pregnancy or birth, or surgery or other trauma to the cervix in the past. It can also be congenital (present from birth).
It may have been caused by genetic factors, such as diethylstilbestrol (DES) exposure. DES is a hormone that was prescribed to some pregnant women from 1938 until 1971.
An infection caught during pregnancy can also cause the cervix to shorten.
You are considered to be at higher risk of having cervical weakness if you have previously had one or more premature births or one or more miscarriages during the second trimester (months four to six of pregnancy).
Treatment for cervical weakness - the cervical stitch/cerclage
If your healthcare team suspect that you may have an incompetent cervix, you may be offered an internal scan to look at the neck of the womb more closely during your pregnancy.
If you have had one or more premature babies or cervical surgery in the past and your cervix is getting shorter in early pregnancy, or if you have had a number of premature deliveries but your cervix has not shortened, you may be offered a cervical stitch (also known as a cerclage or cervical suture).
A special stitch called a cerclage will be put around your cervix to keep it closed. After the operation you may have some cramps similar to period pains, and you may have bleeding and spotting for a few days.
The stitch is usually removed at around 37 weeks so you can give birth. If you go into labour before then, it will be taken out immediately.
The cervical stitch can be put at the top (abdominal) or bottom (vaginal) of your cervix. It is usually put in under regional anaesthetic, such as an epidural, which means you are awake but can't feel anything.
In a very small number of women the stitch does not prevent the membranes from rupturing (waters breaking) and causing a miscarriage. Other rare complications include infections or excessive bleeding.
If you have had a cervical stitch/cerclage
If you have had a stitch, contact your healthcare team immediately if you have any of the following:
- a lot of bleeding
- any smelly greenish discharge
- a fever
- chills
- contractions.
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In this section
Explaining premature birth:
Your premature baby:
You can also read about
Sources
Hatch EE,Troisi R,Wise LA et al (2011) Preterm birth, fetal growth, and age at menarche among women exposed prenatally to diethylstilbestrol (DES), Reproductive toxicology (Elmsford, NY), 31/2(151-7), 1873-1708 (abstract)
Chandiramani M , Seed PT, Ekbote UV et al (2010) CLIC: a longitudinal study of inflammatory markers and cervical change in women at risk of spontaneous preterm labour, Archives of disease in Childhood, Ed 2010;95:Fa10 doi:10.1136/adc.2010.192310.4.5 (abstract)
NICE (2007) Laparoscopic cerclage for the prevention of recurrent pregnancy loss due to recurrent miscarriage, National Institute of Health and Clinical Excellence, p1-2
BMJ Best Practice (2011, accessed Sept 2011) Premature labour, basics, aetiology, http://bestpractice.bmj.com/best-practice/monograph/1002/basics/aetiology.html
Imperial College Healthcare NHS Trust (Revised 2007) Elective cervical suture, Information for patients, London
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Causes of cervical weakness
Treatment for cervical weakness - the cervical stitch/cerclage
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'When I was around 20 I had some pre-cancerous cells and had laser treatment, and that could have made my cervix incompetent. When I was pregnant it never entered my head. I don't think I was told at the time to worry about it in future.'
ELLA
DID YOU KNOW?
If your cervix is less than 2cm long, you are more likely to have your baby prematurely.
'I'd had two miscarriages, but with my next baby I was given an early cervical stitch and carried her to full term.'
MEGAN
DID YOU KNOW?
The cervical stitch was invented in the 1950s.
‘Because of my history, I was booked in to have a vaginal stitch really early – at nine weeks. I had the epidural, but when the doctor attempted to do the stitch, he said there wasn’t enough cervix to work with. So I went in a few days later and had an abdominal stitch done under general anaesthetic. Having major surgery when you’re pregnant feels odd, but I wanted it. In the end I went to 39 weeks and four days.’
AMINA