What is Cervical Insufficiency? Symptoms, Causes and Treatment Methods

Cervical insufficiency is the condition in which the cervix cannot remain strong enough during pregnancy and opens prematurely. This can cause premature termination of pregnancy (miscarriage) or premature birth. In a normal pregnancy, the cervix remains closed until birth and begins to open slowly as birth approaches. However, in women with cervical insufficiency, the cervix can open before birth and without pain.

 

What is Cervical Insufficiency?

Cervical insufficiency is a condition in which the cervix has difficulty staying closed until birth. In a normal pregnancy, the cervix remains strong and closed until the baby matures in the womb. However, in women with cervical insufficiency, the cervix remains weak and may open without labor pain in the second or third trimester of pregnancy. This can lead to premature birth or pregnancy loss.

Basic Features of Cervical Insufficiency:

• Premature Cervical Dilation: The cervix can dilate before labor begins.
• Painless: Cervical insufficiency is usually painless, making it difficult to notice the symptoms.
• Risk of Miscarriage and Premature Birth: Premature dilation of the cervix can lead to pregnancy loss or premature birth.

Cervical insufficiency is a serious condition that can result in pregnancy loss if not diagnosed and treated early.

What Causes Cervical Insufficiency?

The exact cause of cervical insufficiency may not always be clearly determined, but certain factors may predispose to this condition. Structural or physical factors that cause the cervix to weaken, uterine surgeries, and hormonal changes can cause this condition.

Common Causes of Cervical Insufficiency:

• Uterine Surgeries: Previous surgeries on the uterus or cervix can weaken the cervix.
• Previous Miscarriages: Previous recurrent miscarriages can affect the cervix.
• Structural Deformities: Congenital cervical structural defects can cause cervical insufficiency.
• Hormonal Imbalances: Hormonal imbalances can cause the cervix to weaken. can open.

These factors can reduce the cervix's ability to remain closed during pregnancy, causing it to open early.

Cervical Insufficiency Symptoms

Cervical insufficiency usually occurs without any obvious symptoms, and this can cause the pregnancy to end in a miscarriage. However, some early symptoms may indicate the possibility of cervical insufficiency.

Symptoms of Cervical Insufficiency:

• Painless Vaginal Bleeding: Mild to moderate vaginal bleeding may occur.
• Pelvic Pressure: Pressure may be felt in the uterus or pelvic area.
• Vaginal Discharge: Increased vaginal discharge that is different from normal may be seen.
• Early Water Break: Early discharge of the baby's amniotic fluid (early water break) may be a sign of miscarriage or premature labor.

If any of these symptoms are noticed, A doctor should be consulted immediately.

How is Cervical Insufficiency Diagnosed?

Cervical insufficiency can be diagnosed with ultrasound and physical examinations. The length and condition of the cervix are usually checked during routine ultrasounds performed in the second trimester. Shortening of the cervical length is an important indicator of cervical insufficiency.

Cervical Insufficiency Diagnostic Methods:

• Transvaginal Ultrasound: This is the most common imaging method used to measure the length of the cervix. If the cervix is ​​found to be shortened, cervical insufficiency may be diagnosed.
• Physical Exam: The doctor checks to see if the cervix is ​​dilated or softened.
• Pregnancy History: Cervical insufficiency is more common in women who have had a history of preterm birth or miscarriage.

Early diagnosis allows for successful management of pregnancies with cervical insufficiency.

How is Cervical Insufficiency Treated?

Cervical insufficiency can be treated with a variety of methods. Treatment usually involves opening the cervixis done to strengthen the uterus and prevent premature birth. The most common treatment method is cerclage; with this method, the cervix is ​​stitched to keep it closed.

Treatment Methods for Cervical Insufficiency:

1. Cerclage (Stitching to the Cervix): Stitches are placed to keep the cervix closed. Usually 12-14. It is done in weeks and ensures that the cervix remains closed until the end of pregnancy.
2. Bed Rest: Bed rest may be recommended if the cervical length is dangerously shortened.
3. Progesterone Treatment: The use of progesterone in cervical insufficiency can delay labor by preventing the uterus from contracting.
4. Pessary (Cervical Support): It is a device used to support the cervix.

The choice of treatment is determined by the doctor depending on the patient's general health status and how early the cervix opens.

Cervical Insufficiency Risk Factors

Cervical insufficiency may be more common in some women than others. Certain medical conditions in the past may increase the risk of cervical insufficiency.

Cervical Insufficiency Risk Factors:

• Previous Pregnancy Loss: Women who have had a previous second-trimester miscarriage are at higher risk.
• Uterine Surgery: Surgery on the uterus or cervix (for example, conization or LEEP) can weaken the cervix.
• Multiple Pregnancies: Twin or triplet pregnancies can put more pressure on the cervix.
• Family History: Having a family history of cervical insufficiency increases the risk may increase.

These risk factors indicate that women should be carefully monitored throughout their pregnancies.

Cervical Insufficiency and Pregnancy Follow-up

Pregnancies of women with cervical insufficiency should be monitored regularly and closely. In particular, cervical length should be measured regularly and intervention should be made if necessary.

Things to Do for Pregnancy Follow-up:

• Regular Ultrasound: Cervical length and the condition of the cervix should be checked routinely with ultrasound.
• Bed Rest: May be recommended for women at risk of premature birth.
• Progesterone Treatment: Progesterone can prevent uterine contractions and delay birth.

Regular check-ups with your doctor during this period are important for the health of both the mother and the baby.

What is Cerclage and How is it Done?

Cerclage is the process of stitching the cervix to keep it closed. This procedure is usually performed on women with cervical insufficiency and helps prevent premature birth.

Cerclage Procedure:

• When is it done: It is usually performed in the 12th-14th weeks of pregnancy.
• How is it done: The cervix is ​​kept closed by stitching the cervix. When labor approaches (usually at week 37), the stitches are removed.
• Success Rate: Cerclage is very effective in preventing premature labor and provides successful results for many women.

Cerclage is one of the most commonly used and successful treatment methods for cervical insufficiency.

Labor Process After Cervical Insufficiency

In women with cervical insufficiency, the labor process should also be managed carefully. In women with cerclage stitches, the stitches are removed after week 37 and normal birth is possible. However, in some cases, a cesarean section may be required.

Birth Planning:

• Birth After Cerclage: After the stitches are removed, a normal birth can be attempted.
• Cesarean Section: In cases where the cerclage stitch cannot be removed or there are other complications, a cesarean section may be required.

Since each pregnancy is different, birth planning should be done by a doctor.

Recommendations for Mothers Living with Cervical Insufficiency

There are some important points that expectant mothers with cervical insufficiency should pay attention to during their pregnancies. The doctor's recommendations should be followed to prevent further pressure on the cervix and to reduce the risk of premature birth.

Recommendations:

• Bed Rest: If necessary,Take care to rest for the period recommended by your doctor.
• Limiting Physical Activity: Avoid heavy lifting, strenuous activities and standing for long periods of time.
• Regular Check-ups: Do not neglect ultrasounds and examinations as frequently as your doctor recommends.

These measures can help women with cervical insufficiency continue their pregnancy healthily.

Complications of Cervical Insufficiency

Untreated cervical insufficiency can lead to serious complications during pregnancy. This condition can often result in miscarriage or premature birth.

Possible Complications:

• Premature Labor: Cervical insufficiency can cause premature labor before labor pains begin with the opening of the uterus.
• Miscarriage: There is a risk of miscarriage, especially in the second trimester.
• Rupture of the Amniotic Sac: When the cervix opens, the amniotic sac can rupture prematurely, which can lead to the baby coming out of the uterus.

Early diagnosis and appropriate treatment are necessary to prevent these complications.

Frequently Asked Questions (FAQ)

1. How is cervical insufficiency treated?

The most common treatment method is cerclage; the cervix is ​​kept closed by stitches.

2. Is cerclage painful?

Cerclage is usually performed under anesthesia, so you will not feel any pain.

3. Does cervical insufficiency cause premature labor?

Yes, cervical insufficiency can cause premature labor if left untreated.

4. Is vaginal delivery possible after cerclage?

Yes, vaginal delivery is possible after the cerclage stitches are removed, but you should act according to your doctor's recommendations.

5. Can women with cervical insufficiency get pregnant again?

Yes, but future pregnancies need to be monitored carefully as the same problem may occur.