Cervical Insufficiency (incompetent cervix).
The cervix is tubular in shape and joins the end of the uterus to the vagina.
When you are not pregnant, the cervical canal remains slightly open to allow menstrual blood flow out and sperm in. Once you are pregnant, this canal is filled with secretions and this forms a protective barrier referred to as the mucus plug. During a normal pregnancy, the cervix remains long and closed until late in the third trimester. As you body prepares for labour, the cervix softens and starts to dilate.
If you have cervical insufficiency, the cervix begins to shorten and dilate in the second trimester. This may result in a miscarriage or premature delivery.
Routinely at the 12- and 20-week ultrasound, the length of the cervix is measured. If there are any concerns at this stage, the cervix is measured every two weeks by ultrasound to check for early signs of shortening.
Women who are at risk of cervical insufficiency include:
· Those who have had a previous second trimester pregnancy loss
· Congenital abnormalities of the shape of the uterus (this occurs in 1% of the population)
· Previous surgery on the cervix to treat abnormal cells
· Multiple pregnancy
Treatment may include an insertion of a cervical suture. This is where a strong thread is sutured in around the cervix to help keep it closed. This procedure is done in hospital under anaesthetic and requires an overnight stay in hospital. You will be given progesterone support in the form of a pessary to be inserted nightly until 36 weeks gestation. There is no evidence that strict bed rest prevents premature labour or delivery but you will be advised to reduce your activity, refrain from exercise and not to have intercourse. You will be monitored very closely for the rest of your pregnancy.
If there are signs that premature labour is imminent after 24 weeks gestation and an ultrasound indicates that your cervix has shortened further you may be given a course of steroids to help mature the baby’s lungs.
If a vaginal delivery is proposed, the stitch is removed at 37 weeks gestation. This is a simple procedure done in labour ward. If you are having an elective caesarean section, the stitch is removed at the time of surgery.
The insertion of a cervical suture can be a technically challenging procedure. Len has looked after numerous patients with cervical insufficiency and has inserted over 200 cervical sutures.
Dr Len Kliman is one of Melbourne’s most experienced and respected obstetricians and gynaecologists.
With over three decades of experience, Dr Kliman has delivered over 20,000 babies and still counting! He has treated tens of thousands of gynaecological patients.
In 2017, Dr Kliman was awarded an Order of Australia for his services to obstetrics and gynaecology.