Incompetent Cervix

by Tristine Miller and Julie Snyder

What causes incompetent cervix? How is it treated? Are there risks to a cerclage? Learn these answers as a mom shares her experiences and research.

Before the Storm

A week before we lost our son, I had gone into the doctor's office for our 19-week ultrasound. My husband and I were anticipating finding out if we were having a boy or a girl. We were also excited to see real baby features aside from the blobs we had seen at earlier ultrasounds. We had left that office with such pride and we both were glowing from excitement.

A couple days later, I had felt something different. I knew the baby's movements were going to be felt soon. In fact, I thought I had felt a little twinge of a foot or an arm before our ultrasound. But this feeling was something very different. I never had carried a pregnancy this far before so I was not sure what I was feeling. I felt as if the baby had moved somehow, as if the weight of the baby was causing more pressure on my intestines and bladder. Since it did not seem painful nor was it accompanied by other symptoms, I wrote it off as the baby just doing battle with my insides.

Tragedy hit us three days later. I started feeling as if I was constipated. I woke up early Monday morning with pain, but it wasn't regular nor was it unbearable. I drank some prune juice and went back to bed. I awoke only an hour later to more pain. It still was not intense but it did start causing me some more concern. I kept feeling like I had to go to the bathroom but nothing would happen. Finally, I realized something wasn't right and I woke my husband to take me to the emergency room.

I felt that sensation of having to go to the bathroom again. On my way from the bedroom to the bathroom, I felt this huge gush of fluid. Panic set in. I knew my water broke. I screamed for my husband to hurry and get dressed. He helped me lay down on the couch while he gathered his thoughts. I felt down between my legs and could feel something protruding from my vagina. Was it the sac? Was it my son's head? The pain became more intense. I knew I could not sit up in the car so we called for an ambulance.

The paramedics arrived quickly and put me on a stretcher. They were trying to assess what was happening. I heard them mention placenta previa. They thought they were looking at the bag of waters. I could feel my body push. The paramedic told me not to push if I could help it. I tried to stop my body from pushing but had was no control. My son was born one minute before we reached the hospital. It was exactly one week since our ultrasound and the day before my 23rd birthday. Gabriel passed on from this earth an hour later.

What Causes an Incompetent Cervix?

Incompetent cervix accounts for 20-25 percent of all second trimester losses. Many women do not even know they have an incompetent cervix until after they have experienced 2 or more losses in the second trimester.

The causes of an incompetent cervix can range from trauma to the cervix including extensive cervical conization (cervical biopsy), uterine abnormalities and anomalies, exposure to the drug DES (diethylstilbestrol) and undergoing a forced D & C with a late pregnancy termination. Even previous childbirth can weaken the cervix. For some women, there is no definitive cause for an incompetent cervix. There are also claims that an incompetent cervix is over-diagnosed because often the indications for treatment are not always clear.

The Diagnosis

An incompetent cervix can be diagnosed through the use of manual examination. Vaginal ultrasounds are also helpful in monitoring the cervical length and checking to see if the cervix is opening. When the cervical opening is greater than 2.5 cm, or the cervical length has shortened to less than 20mm, a diagnosis can be made for incompetent cervix. Also, funneling of the cervix can be a sign that the cervix has begun to efface.