Cervical Incompetence – Common cause of infertility
Infertility is one of the biggest problems that creates a rift in the marriage and relationships and affects the life of both male and female partners. There are a number of causes that can lead to infertility (inability to conceive) which may be because of discrepancy in male partner or in the female partner.
Among female partners, the most common cause of infertility is long standing pelvic inflammatory infections that lead to scarring of tubes leading to inability to conceive at all. However, there is another female defect in which female is able to conceive but cannot continue pregnancy to term (the phenomena is called secondary infertility)
Cervical incompetence or cervical insufficiency is a well known cause of inability to continue pregnancy and recurrent second or third trimester abortions.
In a normal non-pregnant woman, cervix remains open to allow entry of sperms into tubes so that pregnancy can occur; however once a sperm meets an egg, cervix is closed until the time of delivery. However, in some women even after formation of zygote leading to pregnancy, cervix remains open that eventually leads to loss of developing baby Cervical incompetence is a potential weakness in the cervix due to which fetus is lost before term.
Consequences of Cervical Incompetence:
Due to weak and open cervix, pregnancy may commence successfully until second or early third trimester where weight of fetus exerts excessive pressure on already opened cervix, leafing to:
- Premature rupture of membranes
- Premature onset of labor pain
- Premature birth of the baby
- Miscarriage (if occurs in second trimester)
Risk factors for cervical insufficiency:
There are a number of conditions that may lead to cervical insufficiency, these are:
- Previous history of unexplained pre-mature labor pains or miscarriage increases the doubt of a possible cervical insufficiency and with two or more consecutive second trimester abortions, it is an indication to access pregnant woman for cervical insufficiency.
- Cervical surgery is also a strong risk factor by impairing normal control of muscles.
- Cervical cone biopsy due to abnormal Pap smear is a common reason that may lead to cervical insufficient; however if done properly, risk is very minimal.
- Chemical exposure like Diethylstilbestrol exposure during fetal life also leads to changes in cervix besides increasing the risk of cervical cancer.
- Short cervix: Some women have inherently short cervix and so are risk for developing recurrent second trimester abortions.
What can you do to prevent it?
If you are at risk of developing cervical incompetence due to any of the positive risk factor, you must discuss with your doctor about the possibility in your case. Moreover, there are a number of options available that greatly minimizes the risk of abortion even with cervical incompetence.
Cervical Cerclage is a therapeutic option in such cases. It is a standard procedure of care advised to many pregnant women these days with the history of recurrent (repeated) second trimester abortions. It is performed before mid second trimester and procedure involves binding the lower end of cervix with a stitch in order to provide support against pressure of developing baby.
This cerclage can be removed in late third trimester (35th to 36th week of pregnancy) to ensure a normal labor and delivery.
Apart from that, it is advised to limit physical mobility to minimal during this period and maintain a healthy diet.