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Cervical Insufficiency

A healthy cervix stays long and tightly closed until labor begins. But with cervical insufficiency, your cervix dilates too soon.

Cervical insufficiency may cause miscarriage in the second or third trimester, or premature delivery, if left untreated.

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  • What Is Cervical Insufficiency?
  • What Are the Symptoms of Cervical Insufficiency?  
  • How Do You Diagnose Cervical Insufficiency?
  • How Do You Treat Cervical Insufficiency?

What Is Cervical Insufficiency?  

Doctors define cervical insufficiency as a cervix that's weak and can open or dilate before your baby is due. This condition also may be referred to as cervical incompetence.

The cervix is a tunnel-like opening at the bottom of your uterus. It connects the uterus and vagina, allowing fluids to leave and enter the uterus.

When you’re pregnant, a healthy cervix stays long and tightly closed until 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, the cervix dilates too early. It can cause miscarriage in your second or third trimester or premature delivery.

As your unborn baby grows, their weight presses against your cervix. That also can cause an insufficient cervix to open even without contractions.

How common is cervical insufficiency? 

Premature dilation from cervical insufficiency happens in about 1 out of every 100 pregnancies.

Types of cervical insufficiency

Cervical insufficiency describes a cervix that's either one or both of these:

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

What causes cervical insufficiency?  

Doctors don't know exactly why some people have cervical insufficiency, and women their first pregnancies don't know they have this problem.

Unless you have risk factors, your doctors won't routinely check for cervical insufficiency during prenatal visits.

What are cervical insufficiency risk factors and complications?  

Cervical insufficiency risk factors

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

Other risk factors of cervical insufficiency include:

  • A past miscarriage in your second or third trimester.
  • A prior premature delivery that happened quickly and without contractions.
  • Your mother took diethylstilbestrol (DES) while pregnant with you.

Complications of cervical insufficiency

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

How can I prevent cervical insufficiency?

You can't prevent cervical insufficiency because there's nothing you can do to strengthen your cervix. But you can manage the risks it creates.

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

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What Are the Signs and Symptoms of Cervical Insufficiency? 

Many women who have cervical insufficiency don't have any symptoms.

Common cervical insufficiency symptoms include:

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

When should I see a doctor about my cervical insufficiency symptoms? 

If you have any heavy bleeding or cramping, call your ob-gyn and then go to the emergency department.

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How Do You Diagnose Cervical Insufficiency?

To diagnose cervical insufficiency, your doctor can do:

  • 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.

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How Do You Treat Cervical Insufficiency?  

If you have cervical insufficiency, your doctor will watch your cervix carefully with ultrasounds or pelvic exams.

If they decide you need treatment, they'll either do surgery or prescribe medicine. Both can help prevent your cervix from dilating too early, so you can carry your baby to term.

Medicine for cervical insufficiency

The hormone progesterone not only helps your uterus grow during your pregnancy, but it can 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.

Surgery for cervical insufficiency

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

This procedure is done as outpatient surgery. You'll get medication so you won't feel any pain during the surgery.

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

You can't have this treatment if:

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

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Why Choose UPMC for Cervical Insufficiency Care?

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


By UPMC Editorial Staff. Last reviewed on 2024-09-05.

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