When a pregnancy reaches full term the cervix begins to dilate (open) and efface (shorten) to allow the baby out. Incompetent cervix (or cervical weakness/cervical insufficiency) is the term for when this happens early in the second trimester, sometimes without labour or contractions. It can lead to the waters breaking and late miscarriage or premature birth.
Causes of an incompetent cervix
The cervix may be naturally weak, or the weakness may have been caused during previous pregnancy, previous obstetric trauma, childbirth or uterine abnormalities.
Researchers have found that some people who have an incompetent cervix also have an infection during pregnancy. However, it is not clear whether the infection came first and caused the cervix to open or whether, because the cervix was already open, the infection then spread to this area.
Am I at risk of having an incompetent cervix?
You are considered to be at higher risk of having an incompetent cervix if you have previously had one or more premature births or miscarriages during the second trimester or third trimester. Previous cervical biopsy, or other surgery involving the cervix is also a risk factor.
Treatment for incompetent cervix - the cervical stitch/cerclage
If your healthcare team are concerned about your 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/late miscarriages 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).
This is a special stitch that is put around your cervix to keep it closed. It can be a planned/elective stitch, put in in early pregnancy or an emergency/rescue stitch, put in when the cervix begins to shorten. 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 is normally inserted at the or bottom of your cervix (vaginal stitch). It is usually put in under regional anaesthetic, such as an epidural, which means you are awake but can't feel anything.
If the vaginal stitch fails or if it can’t be inserted, another option is the abdominal stitch (also known as the transabdominal stitch), which is inserted at the top of the cervix before you become pregnant. If you have the abdominal stitch you will need a caesarean section when it comes to time to give birth. This method has a high success rate.
Does the cervical stitch work?
The research on the effects of the stitch is still uncertain but so far it shows that most women who have had cerclage have carried their babies longer than those who have not had cerclage. In a small number of women however the stitch does not prevent the waters from breaking and causing a miscarriage or preterm birth. Other rare complications include infections or excessive bleeding. Ask your doctor to talk you through the risks.
Treatment for incompetent cervix - progesterone
Progesterone is a hormone that plays a role in maintaining pregnancy. There is mixed evidence on the use of progesterone supplementation to treat cervical shortening but it may be recommended by your consultant in addition to or instead of a cervical stitch.
Treatment for incompetent cervix – bed rest
Your doctor may recommend bed rest as part of your treatment. This has not been proven in research trials to be very effective but it is sometimes recommended as a safeguard. Bed rest can happen at home or in the hospital. It can be complete bed rest, remaining in a sitting or reclining position for most of the time, or moderate bed rest, in which you have to stay mainly inactive but can get up and move around and even go to work if your job is sedentary.
Women have said to us that they suffer from feelings of guilt and self-hatred when they go through miscarriage or premature birth caused by incompetent cervix. 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. The word ‘incompetent’ in this context is used as a medical term. It does not describe you or your body.
- 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
- Cockwell HA, Smith GN (2005) Cervical incompetence and the role of emergency cerclage. J Obstet Gynaecol Can. 2005 Feb;27(2):123-9
- Liddiard A, Bhattacharya S (2011) Elective and emergency cervical cerclage and immediate pregnancy outcomes: a retrospective observational study, JRSM Short Rep. Nov 2011; 2(11): 91.
- Conde-Agudelo A, Romero R, Nicolaides K, Et Al. (2013) Vaginal Progesterone Versus Cervical Cerclage For The Prevention Of Preterm Birth In Women With A Sonographic Short Cervix, Singleton Gestation, And Previous Preterm Birth: A Systematic Review And Indirect Comparison Meta-Analysis. American journal of obstetrics and gynecology. 2013;208(1):42.e1-42.e18. doi:10.1016/j.ajog.2012.10.877.
Conde-Agudelo A, Romero R. (2016) Vaginal progesterone to prevent preterm birth in pregnant women with a sonographic short cervix: clinical and public health implications. Am J Obstet Gynecol. 2016 Feb;214(2):235-42. doi: 10.1016/j.ajog.2015.09.102. Epub 2015 Oct 9
- Sosa CG1, Althabe F, Belizán JM, Bergel E. (2015) Bed rest in singleton pregnancies for preventing preterm birth. Cochrane Database Syst Rev. Mar 30;(3):CD003581. doi: 10.1002/14651858.CD003581.pub3.
ℹLast reviewed on October 5th, 2016. Next review date October 5th, 2019.
By Midwife @Tommys on 29 Mar 2017 - 11:37
Hi, thank you for your post I am really sorry you have had bleeding in your pregnancy and don't feel supported by your unit. If you would like to talk we have a midwife weekdays 9-5 pm on 0800 0147 800 and I hope you can stay in contact with us through your pregnancy.
By Anonymous (not verified) on 28 Mar 2017 - 12:28
Hi,i lost four children due to cirvical incompetent. The first one was 23 weeks.second one was 18 weeks,third one 23 weeks again then the last one was 19 weeks.cirvical suturing were done when i was 12 weeks on the last pregnancy but the water came while I'm 19 weeks.i only have one child which is born between those four miscourage .suturing were done and it worked for me until 36 weeks. So I'm willing to try again although I'm getting old 39 years.please help.
By Midwife @Tommys on 28 Mar 2017 - 13:16
I am so terribly sorry to hear of the loss of your four children and cannot even begin to imagine what you have been through during these times. To be able to help you here is difficult as your history is complex. If you live near London you can ask for your GP to refer you to our Preterm clinic at St Thomas' or we can provide you with the details to contact them directly. Please feel free to email us firstname.lastname@example.org and we will try support you best we can.
By Anonymous (not verified) on 25 Mar 2017 - 13:56
Hi I've had pressure from about 13 weeks, I've had some bleeds some of them large some of them light. Constant discharge with mucus and blood. the worse the pain gets the worse the discharge is. I've told them about this but some of them say it could be SPD. No one has mentioned this yet we've had two miscarriages one was a haemorrhage and I needed emergency surgery to stop the bleeding and the second was an incomplete miscarriage and needed a d and c. We've had two live births 11 and 12 years ago. With the first being 4 weeks early.
I don't think they'll investigate this pregnancy because we haven't had 3 miscarriages. I'm now 21 weeks. If they don't investigate how long can I hold on to the pregnancy if this is the case. Or is the fact I've passed clots and it's closed again mean that this isn't a possibility. Sorry I'm desperate to know what's going on and what I can do.
By Midwife @Tommys on 27 Mar 2017 - 09:32
Hi Emma. If you are concerned about your pregnancy, with your history, then you must insist that you have an appointment with an Obstetric Consultant. Your clinic midwife can refer you for a consultant appointment. Alternatively, you can go to your local labour ward, triage or day assessment unit to be reviewed to see if you can get any more answers to your questions. Your midwife and Obstetric team will have full access to your history and medical notes and will therefore have your full clinical picture to make an accurate plan of care for you. It might be sensible for you to have additional scans too, which your midwife or doctor can arrange for you. Please take good care of yourself and feel free to contact us again if you need more advice.
By Anonymous (not verified) on 28 Mar 2017 - 18:48
To be honest we have tried several times to find out what's going on and they've just sort of fobbed us off. I know there's something not right but they don't seem bothered. When you phone to say I've had a bleed they just say if you produce more than a towel an hour then come in. And when you do they leave you for about 4 days for a quick scan. No investigations nothing. It feels as if they only want to know if they can write you off their books for that pregnancy.
By Midwife @Tommys on 25 Jan 2017 - 13:42
Hello thank you for posting. I am so sorry to hear that you have lost four babies due to this.
What care have you had so far in your pregnancies? As you are high risk it would make sense to have a plan in place in your next pregnancy to ensure that you have additional scans, extra antenatal care and possibly your specialist doctors would insert a stitch into your cervix with the hope that this would allow you to carry your baby later into pregnancy.
You need to be referred to a specialist obstetrician through your GP and it would be very important to have your medical notes so that you can have a plan in place to support you in the future.
If you would like further advice please email us at email@example.com or call us on 0800 0147 800. There is hope and amazing specialist teams to support you in the UK.
By Anonymous (not verified) on 24 Jan 2017 - 18:40
Hi, i had four miscarriages as as a result of cervicl insufficiency. Please what can i do to avoid miscarriage?
By Anonymous (not verified) on 27 Dec 2016 - 20:50
Hi, during the summer I had my first pregnancy and at my 20 week scan showed that my cervix was opening and proms. I had a stitch done but my waters broke the next day. Stitches were removed but then didn't go into labour for another three weeks. Gave birth at 23 weeks and baby survived for 2 weeks. I'm nervous to think about another pregnancy. Is it likely this will happen again? What would be the plan if I had another pregnancy?
By Midwife @Tommys on 6 Jan 2017 - 09:25
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 firstname.lastname@example.org and I can give you more detailed information.
By Anonymous (not verified) on 11 Dec 2016 - 23:10
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
By Anonymous (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 Anonymous (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@example.com
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 Deirdre@Tommy's on 13 May 2016 - 09:59
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,
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.