An incompetent cervix can cause problems during pregnancy; a woman with this problem may wonder: can an incompetent cervix be reversed?
What Is an Incompetent Cervix?
The cervix is the narrow end of the uterus that is shaped like a tube and opens into the vagina. In its normal state, the cervix has a small opening where sperm can enter and menstrual fluids can exit. During pregnancy, the cervix develops a mucus plug to seal the small opening and remains closed during the entire pregnancy. During labor, the cervix opens to allow the baby passage through the birth canal.
For some women, the cervix is not as strong as it should be or it is shorter than a normal cervix. These changes can lead to a condition called an incompetent cervix. An incompetent cervix may be caused by:
- Damage from a previous delivery
- Previous surgery on the cervix
- Prior trauma to the cervix
- A birth defect affecting the cervix
- Exposure to DES (Diethylstilbestrol) in the past – usually through your mother taking the medication when she was pregnant with you
Your doctor can evaluate you to determine if your cervix is competent before pregnancy by using ultrasounds. If you have had several miscarriages or preterm labor or deliveries that have no specific cause, your physician will also evaluate you for an incompetent cervix.
Problems Associated with an Incompetent Cervix
A weakened or shortened cervix can thin and open too early during pregnancy due to the weight of the baby pressing on it. The condition can lead to:
- Second trimester miscarriage
- Preterm premature rupturing of membranes
- Premature labor or labor starting before 37 weeks
An incompetent cervix occurs in approximately 1-2 percent of pregnancies. About one quarter of second trimester miscarriages are caused by a weakened cervix.
Management of an Incompetent Cervix
There are a few ways to prevent the adverse effects associated with an incompetent cervix. One way is cerclage, in which the cervix is stitched closed with strong sutures for reinforcement. In women who have had multiple miscarriages or who have been diagnosed with a weakened cervix, the physician would perform this procedure during week 13 to 16. A cerclage is performed under spinal, epidural, or general anesthetic but you can usually go home the same day or on the next day at the latest.
After receiving a cerclage, you will have to refrain from sex—possibly for the duration of your pregnancy. Your physician may also treat you with antibiotics to prevent infection. Even with a cerclage, you will still need to have frequent cervical examinations to make sure that the sutures are still in place and that the cervix is not starting to open to early. Your doctor will remove the stitches at 37 weeks and you can wait for labor to begin.
Cerclage is not without risk. Potential side effects of the procedure include uterine infection, uterine irritation that leads to contractions, or accidental rupture of the membranes. The procedure is not guaranteed to prevent a miscarriage or premature labor but most health care providers believe that the benefits of the procedure are greater than the risks.
Another way to manage an incompetent cervix is strict bedrest. Some physicians may recommend this treatment in addition to cerclage or instead of it. Bedrest does not do anything to improve the strength of the cervix; it only allows the weight of the uterus to be shifted off the cervix.
Can an incompetent cervix be reversed? No, however, it can be reinforced by cerclage. Your physician will determine if this procedure will work for you if you have an incompetent cervix.