Cervical insufficiency and cervical cerclage

What it is

Cervical insufficiency, also called incompetence, is the inability of the cervix to retain a pregnancy in the second trimester, in the absence of uterine contractions. The last part carries the weight: in the absence of uterine contractions.

Causes and risk

Congenital: Mullerian tube defects — bicornuate uterus, septate uterus, unicornuate uterus; Diethylstilbestestrol exposure in utero; and abnormal collagen tissue, such as Ehlers Danlos syndrome and Marfans syndrome.

Acquired: forceful mechanical cervical dilatations; cervical lacerations; and cervical cone or LEEP procedure.

How it is diagnosed

Acute presentation — women present between 18 and 22 weeks with pelvic or rectal pressure of recent onset, and increased mucous vaginal discharge, and no contractions.

Historical diagnosis — women with a history of painless cervical dilatation treated with cerclage in the 2nd trimester of a previous pregnancy; or a history of ruptured membranes without contractions in the second trimester of pregnancy.

Ultrasound diagnosis — cervical length less than 3cm; and bulging or funneling of membranes into the internal os and endocervical canal.