What is cervical insufficiency?
Cervical incompetence is when the cervix is too weak to allow pregnancy to continue. The cervix is the point where the uterus opens into the vagina. In a normal and healthy pregnancy, the cervix is closed, but in cases of cervical insufficiency, the cervix has a much wider opening than the normal opening. In such a situation, the cervix becomes weak and begins to open even before the onset of labor. Cervical insufficiency usually occurs in the second trimester of pregnancy, between 18 and 22 weeks, and often results in miscarriage without appropriate treatment.
How is Cervical Failure (Cervical Failure) Diagnosed?
Cervical Insufficiency is usually diagnosed retrospectively. Between 18 and 22 weeks of pregnancy, the cervix dilates before any pain is felt, then the water sac opens and a miscarriage occurs. Following all these, the pregnancy ends. In addition, the length of the cervix can be measured by ultrasound to check whether it is shorter than expected.
The exact cause of cervical insufficiency is often unknown. The main risk factors for cervical insufficiency are previous conization, insufficient cervical connective tissue and uterine anomalies.
Treatment of Cervical Insufficiency
Surgery to treat cervical insufficiency is called cerclage. With cerclage treatment, the opening of the cervix is brought within normal limits, thus preventing the risk of premature birth and keeping the cervix closed until the end of the pregnancy. The cervix is puckered as if it were the mouth of a bag and tied with a suture that covers the cervix. Cerclage is usually performed in the 12th week of pregnancy. and 14. weeks of pregnancy.
In which cases is cerclage performed?
According to the criteria published by the American Obstetric and Gynecological Society in 2014;
- 2. Trimester painless miscarriage due to cervical insufficiency or previous cerclage due to cervical insufficiency
- 2nd trimester of pregnancy Painless opening of the cervix in trimester (emergency cerclage)
- Previous history of preterm labor and 24. Cervical length less than 25 mm before the week of gestation
In which cases is cerclage not performed?
- If the active labor phase has started
- If the amniotic fluid has come out
- If there is an infection in the uterus
- It is contraindicated if fetal anomaly is detected.
In which cases should a doctor be consulted after cerclage?
Some symptoms may occur after cervical insufficiency has been diagnosed and cerclage has been performed. In cases such as fever above 38 degrees, rhythmic contractions and contractions after cerclage, amniotic fluid, malodorous green and gray vaginal discharge, abnormal vaginal bleeding, nausea and vomiting, you should consult your doctor immediately.