During pregnancy the cervix is blocked by a special antibacterial mucosal plug which prevents infection, somewhat similar to its state during the infertile portion of the menstrual cycle. The mucus plug comes out as the cervix dilates in labor or shortly before. One of the most common problems with the cervix during pregnancy is an incompetent cervix.
Incompetent Cervix and Pregnancy
An incompetent cervix
is one that undergoes abnormal widening during pregnancy. In a normal
pregnancy, the cervix remains tightly closed until the pregnancy comes
to term, at which point the cervix widens due to uterine contractions.
An incompetent cervix thins and widens prematurely, usually between the
third and thirteenth week of pregnancy.
Causes and Risks of Incompetent Cervix
A number of risk factors can cause an incompetent cervix. Cervical cancer biopsies often contribute to an incompetent cervix. Cervical cancer "cone biopsies" are used as a cervical cancer screening tool. Treatment of cervical cancer can cause cervical trauma, damaging the cervix and making an incompetent cervix more likely.
In addition to cervical cancer, any form of cervical trauma or surgery increases the risk of an incompetent cervix during pregnancy. Artificial cervical dilation during an abortion can sometimes damage the cervix.
Other factors that contribute to an incompetent cervix include a history of miscarriages in previous pregnancies, physical cervical abnormalities and cervical birth defects. Women whose mothers took diethylstilbestrol (DES) during pregnancy have an increased risk of an incompetent cervix and miscarriage. DES was prescribed to prevent miscarriage, but was found to cause cervical defects.
In some cases, a pregnancy ends with miscarriage due to a spontaneous incompetent cervix, and no reason for the condition can be found. A future pregnancy has a high chance of developing an incompetent cervix without precautionary treatment to prevent cervical widening.
Diagnosing Incompetent Cervix
An incompetent cervix can be treated if diagnosed early enough. The cervical widening is usually painless. Regular prenatal checkups can detect cervical widening.
An incompetent cervix may cause vaginal spotting and bleeding. Any spotting during pregnancy should be reported to your doctor, no matter what the underlying cause. If not detected soon enough, cervical widening eventually causes premature amniotic membrane rupture (when the "waters" break), starting labor and usually resulting in fetal death.
Incompetent Cervix Treatment: Cerclage
Once an incompetent cervix is diagnosed, treatment may prevent a premature end to the pregnancy. The later in pregnancy an incompetent cervix develops, the better the chances of a successful pregnancy.
Medication may be advised to relax the uterus and prevent premature labor. However, the most successful treatment for an incompetent cervix is a surgical technique known as cervical cerclage.
Cervical cerclage stitches the cervix shut, preventing further cervical widening and lowering the chance of miscarriage. The cerclage stitches stay in place until the pregnancy comes to term, at which point the cerclage stitches are removed.
Cervical cerclage is most often recommended between the fourteenth and sixteenth weeks of pregnancy. After cervical cerclage, bed rest is recommended for a full 24 hours. After this point, exercise should be limited for the remainder of the pregnancy. Plenty of rest is recommended, and sexual intercourse should be avoided until the end of the pregnancy.
Cervical cerclage has a high success rate: between eighty to ninety percent of women who undergo the procedure deliver healthy babies. Cerclage works best when performed early in pregnancy, so prompt diagnosis of an incompetent cervix is essential. Consult your doctor about cervical cerclage if you have a history of incompetent cervix.
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