Cervical incompetence and cervical suture (if required

Cervical incompetence is a serious condition and is caused by weakness of the cervix, which painlessly shortens and dilates in the second trimester.

This can result in recurrent mid trimester pregnancy loss.

The sterile bag of membranes around the pregnancy will eventually bulge through the cervix. They will eventually become infected and ultimately will rupture spreading infection into the uterine cavity. Cervical incompetence declares itself at about 18 – 20 weeks and will often result in the loss of the pregnancy.

Cervical incompetence may occasionally develop later in the pregnancy and will result in very premature delivery, which in turn can lead to cerebral palsy.

It is often seen in women who have had treatment for cervical dysplasia, but it can also occur for no apparent cause. (congenital cervical weakness).

The management ideally involves anticipating this problem in high-risk patients and electively placing a prophylactic cervical suture at 12 – 14 weeks to keep the cervix closed. There are two types of cervical suture:

  • McDonald suture (purse string suture)
  • Shirodka suture (tape inserted under the skin of the cervix and totally concealed)

Cervical Incompetence Treatment

If cervical incompetence appears unexpectedly later in the pregnancy, consideration needs to be given to inserting an emergency stitch or admitting the patient for a prolonged hospital admission. Treatment will involve strict bed rest, with the use of tocolytics, progesterone and antibiotics drugs. In this emergency situation outcomes are less satisfactory.