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Cervical Insufficiency

Recurrent second trimester pregnancy losses can occur due to painless dilation of the cervix.

Written by: Saygı Hospital Health Guide Editorial Board
Last updated:

This content has been compiled by the Saygı Hospital Health Guide Editorial Board and is periodically reviewed by a specialist physician.

References (5)

This content is for informational purposes only and does not constitute medical advice. You can book an appointment at our Kadın Hastalıkları ve Doğum department. Book Appointment →

What is Cervical Insufficiency?

Cervical insufficiency is the early opening of the cervix due to structural or functional inadequacy in supporting the increasing intrauterine pressure as pregnancy progresses. Defects in collagen structure, prior cervical surgeries and congenital uterine anomalies may contribute.

The classic history is recurrent painless second trimester losses. Today, diagnosis can be made during pregnancy with shortening of cervical length (<25 mm) and the formation of a cervical funnel on transvaginal ultrasound.

Treatment includes prophylactic cerclage (McDonald or Shirodkar), ultrasound-indicated cerclage and vaginal progesterone in at-risk pregnancies. Emergency cerclage is considered in cases with intact membranes and a dilated cervix.

Symptoms

Painless feeling of pelvic pressure
Increased watery vaginal discharge
Mild pink spotting
Sensation of vaginal fullness
Mild ache in the lower back
Sudden membrane rupture

Risk Factors

Previous history of second trimester loss
History of conization or LEEP
DES exposure and Müllerian anomalies
Multiple pregnancy
History of traumatic vaginal delivery
Connective tissue diseases such as Ehlers-Danlos

When to See a Doctor?

If you experience any of the following symptoms, seek medical attention promptly:

  • When vaginal pressure or watery discharge occurs in the second trimester
  • For risk assessment in a pregnant woman with previous painless loss
  • When cervical shortening is detected on transvaginal ultrasound
  • When spotting or bleeding is added
  • When cervical opening is felt without regular contractions

Treatment Methods

01
Serial transvaginal cervical length measurement
02
Prophylactic cerclage (12-14 weeks)
03
Ultrasound-indicated emergency cerclage
04
Vaginal progesterone prophylaxis
05
Activity restriction and pelvic rest
06
Cerclage removal at 36-37 weeks and follow-up

Which Department to Visit?

You can visit our Kadın Hastalıkları ve Doğum department for these complaints. Our specialist physicians will create the most suitable treatment plan for you.

Learn About Kadın Hastalıkları ve Doğum Department

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Health Disclaimer: The information on this page is prepared for general informational purposes only. It does not replace medical diagnosis and treatment. Please consult your physician for your complaints. Saygı Hospital does not accept responsibility for actions taken based on the information on this page.