What is cervical insufficiency?
Cervical insufficiency is a condition where the cervix is inadequate to sustain a pregnancy. The cervix is the opening of the uterus into the vagina. In a normal, healthy pregnancy, the cervix is closed, but in cases of cervical insufficiency, the cervix opens much wider than it should. In such a situation, the cervix weakens and begins to open even before labor begins. Cervical insufficiency usually occurs in the second trimester of pregnancy, between weeks 18 and 22, and if not treated appropriately, often results in miscarriage.
How is Cervical Insufficiency Diagnosed?
Cervical insufficiency is usually diagnosed retrospectively. Between weeks 18 and 22 of pregnancy, before any pain is felt, the cervix dilates, then the amniotic sac ruptures, and a miscarriage occurs. Following all of this, the pregnancy ends. In addition, the length of the cervix can be measured via ultrasound to check if it is shorter than expected.
The exact cause of cervical insufficiency is generally unknown. However, a history of conization, insufficient cervical connective tissue, and uterine anomalies are among the main risk factors for cervical insufficiency.
Treatment of Cervical Insufficiency
The surgical procedure performed to treat cervical insufficiency is called cerclage. With cerclage, the cervical opening is brought within normal limits, thereby preventing the risk of premature birth and attempting to keep the cervix closed until the end of pregnancy. The cervix is constricted, as if it were the mouth of a bag, and tied with a suture. Cerclage is usually performed between the 12th and 14th weeks of pregnancy.
In what situations is cerclage performed?
According to the criteria published by the American College of Obstetrics and Gynecology in 2014;
- If you have previously experienced a painless miscarriage due to cervical insufficiency in the second trimester, or if you have previously had a cerclage placed due to cervical insufficiency
- Painless dilation of the cervix in the second trimester of pregnancy (emergency cerclage)
- A history of preterm birth and a cervical length less than 25 mm before the 24th week of gestation.
In what situations is cerclage not performed?
Cerclage;
- If the active labor phase has begun
- If the amniotic fluid has broken
- If there is an infection in the uterus
- It is contraindicated if fetal anomalies are detected.
When should you consult a doctor after a cerclage procedure?
After being diagnosed with cervical insufficiency and undergoing a cerclage procedure, certain symptoms may occur. You should consult your doctor immediately if you experience a fever above 38 degrees Celsius, rhythmic pain and contractions after cerclage, leakage of amniotic fluid, foul-smelling green or gray vaginal discharge, abnormally excessive vaginal bleeding, nausea, or vomiting.
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