Cervical incompetence or cervical insufficiency is a condition when the cervix (cervix) opens too early in pregnancy. This condition can cause sufferers to experience premature labor or miscarriage, especially in the second trimester of pregnancy.
Before pregnancy, the cervix or cervix is normally solid, rigid, and closed. As pregnancy progresses and as you prepare for birth, the cervix will gradually soften and open. However, in pregnant women who experience cervical incompetence, the cervix softens or opens too early.
Causes and Risk Factors of Cervical Incompetence
It is not known exactly what causes cervical incompetence. However, the risk of cervical incompetence is higher in pregnant women with the following conditions:
- Have you experienced sudden premature labor?
- Have you ever had a biopsy or surgery on the cervix?
- Have had a miscarriage in the second trimester
- Ever had an injury to the cervix due to childbirth or curettage?
- Have you ever had synthetic hormones? diethylstilbestrol (DES) before pregnancy
- Have abnormalities in the uterus or cervix
- Have a birth disorder that affects the body's connective tissues, such as Ehlers-Danlos syndrome
Symptoms of Cervical Incompetence
Cervical incompetence does not always cause symptoms, especially during early pregnancy. Generally, new symptoms appear at the age of 14-20 weeks of pregnancy.
Symptoms of cervical incompetence include:
- Feeling pressure in the pelvis
- Back pain that appears suddenly
- Stomach cramps like during menstruation
- Pink or brown vaginal discharge
- Vaginal discharge is more or more liquid
- Light vaginal bleeding (spotting)
When to go to the doctor
Immediately consult a doctor if you experience the above symptoms. Cervical incompetence must be treated quickly so that pregnant women do not miscarry.
Do regular pregnancy check-ups to the obstetrician, so that the condition of the mother and fetus is monitored. Follow the obstetrical examination schedule according to the following schedule:
- Once a month, from the 4th week to the 28th week
- Every 2 weeks, starting from the 28th week to the 36th week
- Once a week, from the 36th week to the 40th week
Diagnosis of Cervical Incompetence
The doctor will ask about the symptoms experienced and the patient's medical history. The doctor will also evaluate whether the patient has any factors that put him at risk for cervical incompetence.
To confirm the diagnosis, the doctor will perform the following tests:
- Transvaginal ultrasound, to measure the depth of the cervix and check if there are amniotic membranes protruding from the cervix
- Examination in the pelvis, to feel whether the amniotic sac protrudes into the cervix or vagina
- Examination of amniotic fluid samples (amniocentesis), to rule out infection in the amniotic sac and amniotic fluid
Cervical Incompetence Treatment
Treatment of cervical incompetence can not only be done in patients who have already experienced it, but can also be done in patients who have not experienced cervical incompetence but are at high risk of experiencing it.
Treatment of cervical incompetence
If on examination it is found that the cervix has opened, treatment can be done by strengthening the cervix with the help of sutures or supports. Here is the explanation:
- Cervical suturing (cervical cerclage)
Cervical suturing can only be done if the gestational age is still 24 weeks or less. This method is usually done if the patient has a history of preterm delivery and the results of ultrasound examination in pregnancy show cervical incompetence. The cervical suture will be opened before delivery.
- Installation pessary
pessary is a tool that serves to support the uterus in order to stay in position. pessary It can also reduce pressure on the cervix.
Management of risk factors for cervical incompetence
Treatments that can be done to prevent miscarriage or premature birth in patients at risk for cervical incompetence include:
- Progesterone supplementationinject
Progesterone supplements (hydroxyprogesterone caproate) is usually given to patients who have a history of preterm delivery. Injections of this supplement are given during the second and third trimesters.
- Ultrasound monitoring
Ultrasound monitoring is performed in patients who have given birth prematurely or have other factors that increase the risk of cervical incompetence. Monitoring was carried out every 2 weeks, from 16 weeks to 24 weeks of gestation.
Complications of Cervical Incompetence
As described above, cervical incompetence can lead to premature labor and miscarriage. Although rare, stitches to treat cervical incompetence can also cause complications, such as:
- Bleeding
- Tearing in the uterus (uterine rupture)
- Tear in the cervix
- Infection
Prevention of Cervical Incompetence
Cervical incompetence cannot be prevented. However, an ultrasound or MRI scan can be done before pregnancy to detect abnormalities in the uterus, which are a risk factor for cervical incompetence.
In pregnant women, the risk of cervical incompetence can be reduced by taking the following steps:
- Conduct regular pregnancy check-ups, so that doctors can know the progress of the condition of pregnant women and fetuses
- Consuming healthy foods that are nutritionally balanced and ensure adequate nutrition that is important for pregnant women, such as folic acid and iron
- Avoid exposure to harmful chemicals, such as cigarettes and alcohol, and consult a doctor before taking drugs
- Controlling weight gain during pregnancy
