Cervical Health Awareness Month
Cervical insufficiency (CI), also known as incompetent cervix, is an obstetric complication in which the cervix is unable to support a full-term pregnancy. This condition is characterised by a history of recurrent pregnancy losses in the second or early-third trimester with no other cause. The prevalence of cervical insufficiency has been estimated to affect 0.5% of the general obstetric population and 8% of patients with a history of previous midtrimester miscarriages (approximately 16-24 weeks gestational age).1
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Pathophysiology of CI
What to know about Cervical Health Awareness Month?
Polycystic Ovarian Syndrome (PCOS)
Another risk factor for CI is polycystic ovarian syndrome (PCOS). The mechanism of hyperandrogenism and its effect on cervical ripening is not fully understood. However, patients with PCOS and associated insulin resistance are at an increased risk for negative pregnancy outcomes including development of CI early in pregnancy and termination of pregnancy at an earlier gestational age.3 Individuals with PCOS may need increased cervical monitoring in the second.
History and Physical Examination
Patients with CI typically present with a history of 1 or more pregnancy losses characterized by early cervical dilation without uterine contractions, pain, or other labour signs. A connective tissue disorder or history of cervical trauma supports the diagnosis. Symptoms of CI are abdominal pressure or cramping, backache, pelvic pressure, increased volume of vaginal discharge (mucous, watery, light bloody discharge), or bleeding.
Diagnosis of Cervical Insufficiency
Patients with CI typically present with a history of 1 or more pregnancy losses characterized by early cervical dilation without uterine contractions, pain, or other labour signs. A connective tissue disorder or history of cervical trauma supports the diagnosis. Symptoms of CI are abdominal pressure or cramping, backache, pelvic pressure, increased volume of vaginal discharge (mucous, watery, light bloody discharge), or bleeding.
