Cervical incompetence, also known as cervical insufficiency, is a pregnancy condition where the cervix dilates and effaces prematurely, potentially leading to miscarriage or preterm birth. It occurs in about 1% of pregnancies and can be diagnosed through history, internal examinations, and ultrasound. Management involves cervical cerclage for reinforcement, along with specific postoperative care and monitoring for potential complications.

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.