CERVICAL INCOMPETENCE

DEFINITION:
Cervical incompetence is the inability of the cervix to
retain intrauterine pregnancy to term because of
deficiency in structure or function resulting to abortion
or premature labour.

Classically it is described as recurrent, painless,

second trimester spontaneous abortion without initial
vaginal bleeding.

INCIDENCE
This is variable from 1 -10 per 1000. It is the
commonest cause of habitual abortion in the mid-
trimester.

Brief History
In 17TH century a form of cervical tear was first
recognised
-1865 Gream in lancent published the term cervical
incompetence
-1902 Hermam treated women by cervical repairs.
-1948 Palmer and Lacombe in UK defined cervical
incompetence.
-1950 Lash and Lash USA also defined cervical
incompetence.
-1955 Shirodkar an INDIAN showed series of
successful cerclage results using facia lata in pregnant
women.
-1957 McDonald an American simplified the cerclage
procedure using non absorbable suture at the Lower
level of the cervix.
-1965 Benson advocated for abdominal approach in
pregnant women
-Wurm an AUSTRALIAN applied 2 mattress sutures
at 12/6, 3/9 O’ clocks.

AETIOLOGY:
This can be Anatomical or Physiological
Anatomical: Congenital
Mullerian abnormalities –bicornate
uterus, uterus didelphys, septate uterus, cervical tags
and perforations.

Diethylstilboestrol:
-Abnormal lower uterine segment
-Short cervix that is flushed with the vagina.
-Short cervical canal
-Few cervical fibrous tissues.
Acquired Anatomical causes:
D&C
Cone biopsy & amputation of the cervix
Lacerations
Normal vaginal deliveries
Precipitate labour
Instrumental vaginal deliveries

Infections: Bacterial activities in the cervix release

cytokines which digest the collagen fibres

Physiological cause: For unexplained reasons the

cervix dilates spontaneously

CLINICAL FEATURES
History of;
Recurrent mid-trimester abortions,
D&C,
Cervical surgeries,
Instrumental vaginal deliveries
Mucoid vaginal discharges &
Rupture of fetal membranes
Examination
Speculum examination of the cervix will show
effacement and dilated cervical os.
Bulging membranes may be seen.
Digital examination will confirm the same

DIAGNOSIS:

Non pregnant state;

-History of cervical trauma following gynaecologic &
obstetrical injuries.
-History of recurrent midtrimester pregnancy losses.
-Digital vaginal examination revealing effaced and
dilated cervix
-Passage of Hegar dilator size 8 starting with larger
sizes.
-Passage of size 16 Foley’s catheter inflated with 1ml
of water.
-Cervico-isthmography or hysterography showing
funnel shaped canal and Abnormal uterus.
MRI

In pregnancy.
-Ultrasound scan using transviginal probe should
measure the internal os
-Width and the cervical length. The bladder should be
empty during the Procedure.
Criteria for diagnosis –
-Length 0f cervix <2 cm.
-Width of internal os =7cm with membranes herniating
into the cervical canal is an ominous sign. Varma et al

-Width of internal os >15mm in the 1st trimester

Mahran et al
-Width of internal os >20mm in the 2nd trimester.
-Cervical canal shortening at 0.41cm/wk between 15-
24wks
-funnelling of the internal os-U or V shape.
-bulging of the membranes into the cervical canal.