CERVICAL INSUFFICIENCY/
INCOMPETENT CERVIX
BACKGROUND
 The cervix opens or shortens
early (During pregnancy, your
cervix is closed at the lower end. It
thins and opens before childbirth.)
 Causes premature birth and
miscarriage
 Occurs in 1 out of 1000 pregnant
women.
 Cervical insufficiency usually
occurs during the middle of the
second or early third trimester,
depending upon the severity of
insufficiency.
 Can be congenital (Ehlers-Danlos
syndrome or Marfan syndrome) or
acquired(most common acquired
cause is cervical trauma such as
cervical lacerations during
childbirth, cervical conization,
LEEP (loop electrosurgical
excision procedure), or forced
cervical dilatation during the
uterine evacuation in the first or
second trimester of pregnancy.).
SIGNS AND SYMPTOMS:
1. Pink Vaginal Discharge
2. Increased Pelvic Pressure
because the baby’s head drop
into the pelvis causing
discomfort to the mother.
3. Back ache due to pelvic
pressure
4. Abdominal Cramps due to
expanding uterus and round
ligament (As the uterus and
surrounding ligaments stretch
to make room for baby, it can
cause short, painful spasms).
RISK FACTORS:
1. Irregular shaped of the
cervix/uterus due to HPV
infection most important risk
factor for cervical dysplasia
(abnormal growth of the cell on
the surface of the cervix).
- HPV (Human
Papillomavirus)- A
common sexually
transmitted infection which
usually shows no
symptoms. !!Usually affect
those women having
multiple sex partners.
2. Premature birth
3. Miscarriage
4. Injured cervix during previous
pregnancy due to vaginal birth,
cervical tears during labor, and
dilation and curettage (D&C) a
procedure that remove tissue from
inside of your uterus to clean
excessive bleeding and clears
uterine lining from an abortion or
miscarriage may also cause
cervical trauma.
5. Genetic disorder: Ehlers-Danlos
- The most common
congenital cause is a
defect in the embryological
development of Mullerian
ducts (paired tubes that
grow into female
reproductive organs early
in fetal development.
The ducts form the uterus, cervix,
fallopian tubes and upper vagina,
developmental abnormalities in the ducts
can lead to infertility or other health
issues.) In Ehlers-Danlos syndrome or
Marfan syndrome, due to the deficiency in
collagen, the cervix is not able to perform
adequately, leading to insufficiency.
DIAGNOSTIC PROCEDURE:
• Pelvic Exam
• Transvaginal ultrasound (Endovaginal
ultrasound, is a type of pelvic ultrasound
used by doctors to examine female
reproductive organs.)
MEDICAL SURGICAL TREATMENT:
• PROGESTERONE SUPPLEMENT
 To prevent spontaneous
miscarriage
 Treat recurrent miscarriage
 Experiencing bleeding

• REPEATED ULTRASOUND
 The HC will monitor frequently if
membranes are protruding
through the cervix.

•CERVICAL CERCLAGE
2 TYPES:
1. MCDONALD’S CERVICAL
CERCLAGE
 Suture is placed around the cervix
in purse-string fashion and
securely tied anteriorly.
 Most common technique.
 The patient is placed in DORSAL
LITHOTOMY POSITION.

2. SHIRODKAR’S CERCLAGE
 A transverse incision made in the
vaginal mucosa of the anterior
cervix to allow for upward
displacement of the bladder to
avoid injury.
 Altered cervical anatomic
conditions.