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Cervical Insufficiency

Contact Maternal Fetal Medicine at UPMC-Magee Womens Hospital

To make an appointment with a maternal fetal medicine expert, call 412-641-6361.

What Is Cervical Insufficiency?

Doctors define a cervical insufficiency as one that is weak and can open well before your baby is due.

Your cervix is a tunnel-like opening at the bottom of your uterus.

A healthy cervix stays long and tightly closed until your labor begins. When you're ready to give birth, your cervix thins out, shortens, and dilates (opens) so your baby can pass through.

With cervical insufficiency, it dilates too early. This happens in about 1 out of every 100 pregnancies.

It may cause miscarriage in your 2nd or 3rd trimester or premature delivery.

Types of cervical insufficiency

A cervical insufficiency is one or both of these:

  • Short (less than 25 mm long).
  • Structurally weak.

Cervical insufficiency causes

An abnormally short cervix or one that is weak might be due to:

  • A birth defect in the shape of your cervix, or in your cervical tissue causing it to shorten prematurely when you're pregnant.
  • Exposure to a type of estrogen called diethylstilbestrol (DES) while you were in your mother's womb.
  • An injury to your cervix from a prior pregnancy, surgery, or treatment like a D&C.
  • A past miscarriage or an abortion.

Many times, doctors don't know the cause of cervical insufficiency.

Cervical insufficiency risk factors and complications

If you had a previous pregnancy loss due to cervical insufficiency, there's up to a 30% chance it may happen again.

But, in a first pregnancy, most women don't know if they have this problem.

And doctors don't routinely check for it during your prenatal visits unless you have risk factors such as:

  • A past miscarriage in your 2nd or 3rd trimester.
  • A prior premature delivery that happened quickly and without contractions.
  • Your mother took DES while pregnant with you.

As your unborn baby grows, their weight presses against your cervix. That can cause a cervical insufficiency to open even without contractions.

Left untreated, it increases your risk of pregnancy loss or early labor.

How to prevent cervical insufficiency

You can't prevent this condition, but there are ways of managing the risks it creates, as discussed below.

It's crucial to get routine prenatal care so your doctor can watch for any changes in your cervix. They can also refer you to a team of high-risk pregnancy specialists if needed.

If you're at risk, there are tests to diagnose it and methods that can help you have a healthy pregnancy.

Why choose UPMC Magee-Womens Hospital for cervical insufficiency care?

  • Maternal fetal medicine at Magee offers care for high-risk pregnancies from national and global experts.
  • Our skilled team knows how to diagnose and treat cervical insufficiency.
  • We're trained in evidence-based obstetrical care for women with complex pregnancies

Cervical Insufficiency Symptoms and Diagnosis

Many women with this condition don't have symptoms.

But you might have:

  • A feeling of pressure in your pelvis or lower belly.
  • Cramps.
  • Back pain.
  • Light bleeding or a change in discharge from your vagina.

If you have any heavy bleeding or cramping, call your doctor and then go to the ER.

Diagnosing cervical insufficiency

Your doctor can diagnose this condition with:

  • A pelvic exam of your cervix.
  • A transvaginal ultrasound to get a close view of your cervix and measure its length. While you may feel some discomfort, this test shouldn't hurt.

Cervical Insufficiency Treatments

Your doctor will watch your cervix carefully with ultrasounds or pelvic exams and decide if you need any treatment.

There are 2 treatments that can prevent your cervix from dilating too early, so you can carry your baby to term.

Cervical cerclage

With a cervical cerclage, your doctor goes in through your vagina and stitches your cervix closed. It helps strengthen your cervix, so it's less likely to shorten and dilate.

This is outpatient surgery. You'll get medicine so you won't feel any pain during the surgery.

Your doctor can do a cervical cerclage early in your 2nd trimester. They'll remove the stitches when you're about 36 weeks pregnant and it's safe to have your baby.

You can't have this treatment if:

  • You're carrying more than 1 baby.
  • Your water breaks.

Progesterone treatment

Progesterone is a hormone that helps your uterus grow during your pregnancy. It also prevents contractions from starting.

If you're carrying only one baby, taking progesterone supplements can reduce your risk of having a miscarriage or premature labor.

Your doctor might prescribe progesterone until you're 36 weeks pregnant.

It comes in the form of:

  • Weekly shots if you've had a premature birth before.
  • Vaginal pills if you have a short cervix but no prior premature births.