An overview of cervical incompetence, including etiology, symptoms and approach to diagnosis and treatment.

1. CERVICAL INCOMPETENCE (CERVICAL
INSUFFICIENCY)
Ms. Parijat S
Masters in OBG Nursing

2.  Cervical incompetence or cervical insufficiency
or cervical weakness, is a medical condition
of pregnancy in which the cervix begins
to dilate (widen) and efface (thin) before the
pregnancy has reached term.

3.  Cervical weakness may cause miscarriage or preterm
birth during the second and third trimesters.
 It has been estimated that cervical insufficiency
complicates about 1% of pregnancies, and that it is a
cause in about 8% of women with second
trimester recurrent miscarriages.

4. Causes
The retentive power of the cervix (internal os) may
be impaired due to the following conditions:
Congenital Uterine anomalies
Acquired (iatrogenic)—common, following
Others—multiple gestations, prior preterm birth

5. Acquired (iatrogenic)—common, following:
 D and C operation
 Induced abortion by D and E (10%)
 Vaginal operative delivery through an undilated
cervix
 Amputation of the cervix or cone biopsy

6. Fig. Amputation of the cervix

7. Fig. Cone biopsy

8. Clinical features
 In cases of cervical weakness, dilation and
effacement of the cervix may occur without pain
or uterine contractions.
 Cervical weakness becomes a problem if rupture
of the membranes occurs leading to birth of a
premature baby.

9. DIAGNOSIS
History
Repeated mid trimester painless cervical
dilatation (without apparent cause) and escape of
liquor amnii followed by painless expulsion of the
products of conception are very much suggestive.

10. Internal examination
 Interconceptional period—Bimanual examination
reveals presence of unilateral or bilateral tear
and/or gaping of the cervix up to the internal os.
 Speculum examination: Detection of dilatation of
internal os with herniation of the membranes

11. USG
 Assessment of cervical length in second trimester
to identify cervical shortening( <25mm),
Funneling of the internal os > 1 cm

13. Assessment of the patulous cervix with Hegar
or Pratt dilators.
 Passage number 6–8 Hegar dilator beyond the
internal os without any resistance and pain
indicate incompetence

14. Fig. Hegar dilators

16. MANAGEMENT
Surgical
 Cervical weakness can be treated using cervical
cerclage, a surgical technique that reinforces the
cervical muscle by placing sutures above the
opening of the cervix to narrow the cervical canal.

18. POSTOPERATIVE CARE
 The patient should be in bed for at least 2–3
days.
 Weekly injections of 17α-hydroxyprogesterone
caproate 500 mg IM are given in women with
history of prior preterm delivery.
 Isoxsuprine (tocolytics) 10 mg tablet may be
given thrice daily to avoid uterine irritability.

19. ADVICE ON DISCHARGE
 Usual antenatal advice.
 To avoid intercourse.
 To avoid rough journey.
 To report if there is vaginal bleeding or abdominal
pain.
 Periodic ultrasonographic monitoring of the fetus
and the cervix.

20.  Removal of stitch: The stitch should be removed
at 37th week or earlier if labor pain starts or
features of abortion appear.
 If the stitch is not cut in time, uterine rupture or
cervical tear may occur.