| Cervical insufficiency | |
|---|---|
| Specialty | Obstetrics and gynaecology  |
Cervical weakness, also called cervical incompetence or cervical insufficiency, is a medical condition of pregnancy in which the cervix begins to dilate (widen) and efface (thin) before the pregnancy has reached term. Definitions of cervical weakness vary, but one that is frequently used is the inability of the uterine cervix to retain a pregnancy in the absence of the signs and symptoms of clinical contractions, or labor, or both in the second trimester.[1] Cervical weakness may cause miscarriage or preterm birth during the second and third trimesters. It has been estimated that cervical insufficiency complicates about 1% of pregnancies, and that it is a cause in about 8% of women with second trimester recurrent miscarriages.[2]
A sign of cervical weakness is funneling at the internal orifice of the uterus, which is a dilation of the cervical canal at this location.[3]
In cases of cervical weakness, dilation and effacement of the cervix may occur without pain or uterine contractions. In a normal pregnancy, dilation and effacement occurs in response to uterine contractions. Cervical weakness becomes a problem when the cervix is pushed to open by the growing pressure in the uterus as pregnancy progresses. If the responses are not halted, rupture of the membranes and birth of a premature baby can result.
The older terminology is perceived as blaming the woman for the miscarriage, as if she were an incompetent or insufficient person. Consequently, cervical weakness is the recommended term.[4]
- ^ American College of Obstetricians and, Gynecologists (Feb 2014). "ACOG Practice Bulletin No.142: Cerclage for the management of cervical insufficiency". Obstetrics and Gynecology. 123 (2 Pt 1): 372–9. doi:10.1097/01.AOG.0000443276.68274.cc. PMID 24451674. S2CID 205384229.
- ^ Alfirevic, Zarko; Stampalija, Tamara; Medley, Nancy (2017). "Cervical stitch (cerclage) for preventing preterm birth in singleton pregnancy". Cochrane Database of Systematic Reviews. 2017 (6): CD008991. doi:10.1002/14651858.CD008991.pub3. ISSN 1465-1858. PMC 6481522. PMID 28586127.
- ^ Cervical assessment from Fetal Medicine Foundation. Retrieved Feb 2014.
- ^ Christiansen, Ole (2014). Recurrent pregnancy loss. Chichester, West Sussex, UK: John Wiley & Sons. pp. 98–99. ISBN 9780470672945.
It is important to bear in mind that some clinical terms can cause great distress and even anger. The terms "blighted ovum" and "cervical incompetence" both imply blame. Cervical incompetence is better described as cervical weakness.