Cervical incompetence

When the cervix shortens and opens in the second trimester (16 to 24 weeks) or early in the third trimester without any other symptoms of labour it may be referred to as cervical incompetence or cervical insufficiency.

The cervix is the canal at the base of the womb (uterus) that connects it to the vagina. It is also known as the neck of the womb. When a pregnancy reaches full term the cervix begins to shorten (efface) and open (dilate), allowing the baby to be born. This is part of the normal labour and birth process.

When the cervix shortens and opens in the second trimester (16 to 24 weeks) or early in the third trimester without any other symptoms of labour it is sometimes referred to as "cervical incompetence" as this term is sometimes used incorrectly instead of “preterm birth”. True cervical incompetence, in which there is a structural problem with the cervix, is uncommon and most women who have a preterm birth will not have any problems in their following pregnancies, even without treatment.

What we discuss here is the cases in which there is a structural weakness in the cervix that caused preterm birth.

Structural cervical problems that are linked to premature birth

  • You may have undergone treatment for cervical cancer or precancerous cells such as trachelectomy (surgical removal of the cervix), LLETZ procedures or cone biopsy. In some cases, quite a lot of cervix may have been removed and it is a good idea to ask your gynaecologist whether more than 1 cm of tissue was removed.
  • You may have experienced previous obstetric cervical trauma, such as cervical tearing during labour or prior dilation and curettage (D&C). This involves opening the cervix and surgically removal of part of the lining of the uterus and/or contents of the uterus, for example carried out after a first trimester miscarriage or abortion.
  • You may have undergone a full or partially dilated emergency caesarean section in a previous pregnancy and had damage to the top of your cervix during the delivery of your baby.
  • You may have been born with a connective tissue disorder such as hypermobility or ehlers danlos syndrome, which effects the collagen within the tissues of the cervix causing it to be weak.
  • You may have been exposed to DES (Diethylstilbestrol) in the womb. DES was given to women up until 1971 as it was thought to prevent miscarriage but it has since been linked with issues of the reproductive system and preterm birth in those whose mother’s took it while pregnant.
  • You may have a uterine abnormality. Uterine abnormalities have not been shown to affect the structure of the cervix but they are linked to preterm birth.
  • You may have been born with a naturally weak or short cervix and this may be genetic .

If your cervix has been found to measure less than 25mm’s (2.5cm) during pregnancy it is a cause for concern and you should be treated as high risk for preterm birth. You may need treatment. You should also be monitored closely during future pregnancies.

Symptoms of cervical incompetence in pregnancy

There are no obvious symptoms you can look out for of the cervix opening too soon, whether this is due to cervical incompetence or other causes. Your cervix can shorten and dilate without any other signs.

If you have been told you are at risk of premature birth or you have any of the cervical problems listed above, it is important that you are monitored regularly in your pregnancy. This will include checks on the length of your cervix.

A pregnancy that has a risk of premature birth can be very scary. If at any time you are worried about any signs or symptoms you are experiencing; then you should contact your midwife immediately.

Look out for the symptoms below that could indicate premature labour.

  • an increase in pelvic pressure within the vagina or rectum.
  • an increase in discharge and/or a gush/repeat trickling of fluid, which could mean your waters have broken (preterm premature rupture of membranes).
  • bleeding or losing your mucus plug.
  • period type pains in your abdomen or lower back. These may have a rhythm or be constant.

Do I have cervical incompetence?

You are at higher risk of having cervical incompetence if you:

  • have previously had one or more premature births or miscarriages during the second or early third trimester
  • have any of the factors listed above.

A note on intrauterine infection and preterm birth

If you had an intrauterine infection (chorioamnionitis) in a previous premature birth, it is important to ensure your consultant considers the cervical problems listed above rather than assuming infection was the cause of the birth.

When a woman gives birth early the cervix shortens some time before birth. This allows bacteria (which are normally present in the vagina) to move up into the womb, which can develop into an infection.

Therefore it is very possible that it is the short cervix that allowed the infection to develop, rather than the infection causing the cervix to shorten and open.

Treatment for cervical incompetence

If your doctor thinks you are at risk of cervical incompetence or premature birth the length of your cervix will be monitored and if it is found to be short, treatment will be focused on prolonging your pregnancy.

You will have regular monitoring during your pregnancy with:

  • transvaginal scans (an ultrasound wand that is inserted into the vagina to give the best view of the cervix length)
  • vaginal swabs for markers of preterm birth (for example fetal fibronectin - a substance that is only present in the vagina when you are at increased risk of going into early labour)

This monitoring can be reassuring, or else can predict an increased chance of early delivery, before you are able to detect any symptoms yourself. It should start between 14-16 weeks of pregnancy.

Some consultants may also recommend antibiotic treatment to try and reduce the risk of infection, for example an antibiotic pessary that is inserted for one week of each month to try and prevent an infection happening. There is no evidence currently to support that this practice reduces the risk of early delivery.

If you are at very high risk of giving birth prematurely with cervical incompetence, the most common treatment is a stitch / cerclage, although the Arabin Pessary and vaginal progesterone are also recognised treatments for a short cervix.

Women without cervical incompetence but who have other risk factors for premature birth or whose cervix is shortening for other reasons may also benefit from the cervical stitch.

Read more about the cervical stitch and other treatments currently in use across the UK for cervical insufficiency and premature birth.

Research into cervical incompetence.

Our knowledge about cervical incompetence and the role it plays in premature birth is limited. For this reason, you may be asked to participate in research. It is your decision whether you wish to take part or not. Research into the causes and treatments for premature birth is very important to ensure that women receive the safest possible treatments with the best outcomes for both themselves and their babies and is a very important part of work done by Tommys.

Your feelings about cervical incompetence

Women have said to us that they suffer from feelings of guilt and self-hatred when they go through a late miscarriage or premature birth caused by cervical incompetent. This is very sad as the situation is not your fault, and usually there is nothing that you could have done to make a difference. It is important to seek professional help if you feel you are not coping and need support.

Some women do not like the term ‘incompetent cervix’, but it is used as a medical term. It does not describe you or your body.

Support groups for cervical incompetence

Support after loss and in subsequent pregnancies that are at risk of premature birth is very important. Being among those who understand all of your worries and concerns can be very comforting in your times of need. There are currently two support groups running on Facebook that are UK and Ireland based purely dedicated to cervical incompetence support. You can request to join if you need support.

Incompetent Cervix UK - a Facebook group for anyone and everyone in the UK and Ireland who would like advice, info or support on any aspect of cervical insufficiency.
UK TAC Support Group - a Facebook group specifically for women who have a transabdominal cerclage or are thinking of having one placed in the UK or in Ireland. It has been award nominated for the support it provides to its members.

Both groups send out joining messages to keep out trolls and selling pages, so please look out for a joining message from the admin team after you request to join.

Read more about the cervical stitch and other treatments currently in use across the UK for cervical insufficiency and premature birth.

Sources

  • NICE (2007) Laparoscopic cerclage for the prevention of recurrent pregnancy loss due to recurrent miscarriage, National Institute of Health and Clinical Excellence
  • J David, Steer P et al (2010) High risk pregnancy, management options, Elsevier Saunders
  • https://www.uptodate.com/contents/cervical-insufficiency.
  • Warren JE1, Silver RM (2009) Genetics of the cervix in relation to preterm birth. Semin Perinatol. Oct;33(5):308-11. doi: 10.1053/j.semperi.2009.06.003
  • Personal communication, Professor Andrew Shennan, Professor of Obstetrics at King's College London
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Read more about premature birth

Last reviewed on June 12th, 2017. Next review date June 12th, 2020.

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Comments

Please note that these comments are monitored but not answered by Tommy’s. Please call your GP or maternity unit if you have concerns about your health or your baby’s health.
  • By Midwife @Tommys on 6 Jan 2017 - 09:25

    Hi,
    Firstly I am so sorry to hear what you have been through and the loss of your baby. I am afraid I am unable to give you a definite answer as do not have access to your notes and medical history. If you are thinking about another pregnancy then I would advise for you to speak to your GP and be referred for preconception counselling where you can talk through the care that you can expect in a next pregnancy and review what happened to cause you to lose your baby. If you would like more information and to talk further about this then please do email us [email protected] and I can give you more detailed information.

  • By Anonymous (not verified) on 11 Dec 2016 - 23:10

    Hi
    I have had a miscarriage at 9 weeks in June and got pregnant again in July of this year. I went into labour at 22 weeks and sadly lost my little girl. His this liking due to cervical incompetence? Is liking to happen again and can it be prevent.

  • By Midwife @Tommys on 12 Dec 2016 - 09:17

    I am ever so sorry to hear about your miscarriage and the passing of your daughter. That is ever so sad and I can only imagine how you and your partner are feeling.
    It would be a good idea to go to see an Consultant in Obstetrics and Gynecology as soon as you feel able to, to discuss your history and why this may have happened(your GP can refer you). Sometimes, these events are sadly unexplained, but one of the possible outcomes could be an incompetent cervix. It would be good for you to have this discussion with the specialist with your case notes too, so that they can arrange for further investigations if these are required, or to make a plan of care for if you decide to try to conceive again. Good luck and please take care of yourself.

  • By Anonymous (not verified) on 12 Dec 2016 - 12:06

    Thank you.

  • By shelly (not verified) on 3 Dec 2016 - 04:32

    Hi, i gave birth through oparation and on the 3rd i got miscarage, since i felt pragnent i always feel strong pain on my cervical what is the cause of ...?

  • By Midwife @Tommys on 5 Dec 2016 - 09:14

    It is a little difficult to understand what it is that you are trying to ask.
    I would suggest that if you are pregnant and are having pains, then you seek urgent medical advice from your GP or a Midwife at hospital where you can be reviewed and possibly scanned.
    Please take care of yourself.

  • By Sanam (not verified) on 20 Oct 2016 - 19:42

    Hello. I've been given the go ahead for my abdominal cerclage but I'm scared of the risks as I have adhesions between my bladder and omentum from my previous c section. I'm at risk of bladder injury. Should I risk my health for more children? I have two already. Could this mean I will be on a urine bag for the rest of my life if things go wrong?

  • By Midwife @Tommys on 21 Oct 2016 - 09:53

    Hi, it is difficult to answer your question fully. I am assuming that you are pregnant at the moment if you have been given a go ahead for an abdominal cerclage? There should be notes regarding the extent of the adhesions, I feel it would be beneficial for you to speak to your consultant regarding your concerns and any possible risks before you can make nay decisions. I can assure you that adhesions are not uncommon and women do have more children and do not have permanent bladder injury, it is unlikely for you to end up with a urine bag however I feel you do need to be reviewed and have a full consultation with your notes.

  • By Midwife @Tommys on 18 Aug 2016 - 11:24

    Hi, I am so sorry to hear what you have been through in your last pregnancy and losing your little boy. It is completely understandable that you are feeling so anxious and terrified in this pregnancy. Cervical length is not measured as a routine, only done if there is deemed to be a risk of you labouring early in pregnancy. If there was any risk this should have been identified by the midwife at your booking and a plan put in place for you. If you would like to talk further about this or would like some more information then please do call a midwife on 0800 074 800 or email [email protected]

  • By Anonymous (not verified) on 18 Aug 2016 - 06:11

    Hello. Is cervical length something they will check at the anomoly scan at 16 or 20 weeks. Is it worth paying for the scan private if not. I have no history of miscarriage. We just had to terminate our last pregnancy at 17 weeks because our boy had a severe heart condition. I am terrified of losing this baby too. Thank you for your help.

  • By Midwife @Tommys on 15 Aug 2016 - 14:43

    Hi, It sounds as if you have had a difficult time with the miscarriages and it takes time to recover. However, if you have pelvic pain I would suggest you see your GP or you could call us on 0800 0147 800.

  • By Midwife @Tommys on 15 Aug 2016 - 10:54

    Hi, So sorry to hear about your two miscarriages. Even though about 1:4 pregnancies ends in miscarriage the reasons are sometimes never known and your miscarriage may or may not be associated with cervical problems. Please feel free to contact us at Tommy's on 0800 0147 800 where we may be able to advise you.

  • By Anonymous (not verified) on 12 Aug 2016 - 17:58

    I had two missriage.my water burst when is not time for delivery at sixteen weeks.pls I need answer.

  • By Midwife @Tommys on 3 Aug 2016 - 12:44

    Hi, thank you for your message. As your pregnancy progresses the growing baby exerts pressure on your organs and this, of course includes your pelvic floor. Women often complain of pressure in the lower back, heaviness in the lower abdomen, vaginal pressure and sometimes rectal. This may be due to the weight gain and position of your baby. However with additional symptoms it may also be a sign of preterm labour.
    Please feel free to call us at Tommy's 0800 0147 800 as each pregnancy is different.

  • By Anonymous (not verified) on 3 Aug 2016 - 11:47

    I don't have a history of mid trimester miscarriage but I feel a lot of pressure at the moment and it feels like the baby is trying to escape. That is the only way I can explain this feeling. It's making me very anxious about possible incompetent cervix. It's my second baby and I had no complications with my first. No vaginal pressure until I delivered. I hate this feeling and I'm driving myself insane.

  • By Anonymous (not verified) on 4 Jul 2016 - 05:37

    Evn i lost my prrgnency in 21weeks coz of cervic opened, doctor said its impossible to put stitch coz opened cervix centimeter is more, so thy terminated my baby. It was boy

  • By [email protected]'s on 13 May 2016 - 09:59

    Hi,
    This one is difficult to answer without knowing the specifics of your case. Would you like to call our midwives on 0800 0147 800? They should be able to help. They are on the line Mon-Fri, 9-5pm.
    Hope this helps,
    Tommy's

  • By Anonymous (not verified) on 12 May 2016 - 21:40

    I want to know if a cervix can grow strong again after being damaged.

  • By Anonymous (not verified) on 9 Feb 2017 - 08:32

    Can it be strong again?

  • By Midwife @Tommys on 9 Feb 2017 - 12:51

    Hi, It is difficult to answer this question without more information. I am unsure if you are asking about whether your cervix will change or whether you are referring to your pelvic floor muscles. Your are welcome to call our pregnancy information line on 0800 0147 800 to clarify and discuss this.

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