What is an 'incompetent cervix?' Why experts want women to know the pregnancy complication 'is not their fault'

After Chrissy Teigen and John Legend suffered a pregnancy loss in Sept. 2020, the cookbook author and model set out to dispel the stigma behind fertility struggles and infant loss. In partnership Peanut, an app and community for moms and women trying to conceive, Teigen sparked a conversation about outdated terms, including "geriatric pregnancy," "barren" and "biological clock"

Another term Teigen and Peanut want to see updated is "incompetent cervix," an unflattering term that's not exactly a confidence booster for those who've been diagnosed.

"It's a terrible term," says Dr. Nicole Rankins, a board-certified OB/GYN in Richmond, Va. "Apparently, someone just wanted to make women feel bad. Many doctors now prefer to refer to the condition as 'cervical insufficiency,' but I don't know if that's any better."

In Peanut's Renaming Revolution Glossary, a publication being released to clinics and doctors in hopes of encouraging the use of more sensitive, modernized language, they've renamed the term "early cervical dilation."

But what is an incompetent cervix? And what are the causes, symptoms and treatment for the pregnancy complication?

What is an incompetent cervix?

Rankins says cervical insufficiency happens when there's painless dilation, or opening, of the cervix, typically in the second trimester of pregnancy, or during weeks 13 through 28.

"Unfortunately, we can't diagnose it until it happens," says Rankins, who hosts the All About Pregnancy and Birth podcast. "Sometimes we'll have a suspicion based on the length of the cervix in an ultrasound, but most often it's diagnosed after a woman has a second trimester preterm birth or pregnancy loss."

Preterm birth and pregnancy loss are the two most difficult challenges that come with cervical incompetence, according to Rankins. Often a woman will feel downward pressure with no contractions beforehand. Because the cervix is weak or short, it doesn't stay closed and won't "hold the pregnancy" in the uterus.

Barbara Premoli, a child care provider in Egremont, Mass., had a smooth pregnancy until she was 21 weeks along. "I was three centimeters dilated and didn't even know," says Premoli. "I had to rush myself an hour away to another hospital for treatment."

Premoli was in and out of the emergency room almost weekly due to labor pains and pain caused by uterine fibroids. Her doctor counseled her not to strain to have a bowel movement and not to have sex.

Rankins says this is typical advice when early cervical dilation begins.

"We generally advise women not to do anything that will stimulate the cervix when they're diagnosed with this condition," Rankins explains.

What causes cervical incompetence?

"There is some evidence to suggest that genetics may play a part here," says Rankins, explaining that weak cervical tissue can be part of congenital abnormalities.

When Kelly Napierata's sister suffered the loss of her son after just 20 weeks of pregnancy, she was diagnosed with cervical insufficiency. "My sister and I see the same OB/GYN and he decided to watch me very closely based on my sister's experience," says Napierata, a mother of two from Orlando, Fla. "Sure enough, I was diagnosed at 20 weeks when my cervix drastically shortened."

Other potential causes of incompetent cervix include prior cervical surgeries (such as those that treat and remove pre-cancerous cells) or uterine surgeries. "We don't see very much of this anymore though thanks to the human papillomavirus (HPV) vaccine, which prevents cervical cancer in the first place," says Rankins. "But once you've been diagnosed [with an incompetent cervix] the first time, it's something your doctor will always keep an eye on with subsequent pregnancies."

Treatment options are increasing

There are two main treatment options for women facing weak cervical tissue. The first is a cerclage — stitches placed at the base of the cervix to keep it closed.

Napierata was too far along for a cerclage, so she was placed on bedrest for the remainder of her pregnancy. "I ended up delivering at 34 weeks," she says. "Five years later, during my second pregnancy, my doctor placed a cerclage on my cervix at 13 weeks."

After her initial loss, Napierata's sister went on to have a healthy pregnancy. "She had a cerclage as well and delivered at 29 weeks. My niece survived and is healthy," she says.

Rankins says cerclages have about a 70 to 80 percent success rate when placed early enough in pregnancy.

Once a patient has been diagnosed with the condition, progesterone supplementation is also an option.

"There's some evidence that progesterone strengthens cervical tissue," says Rankins. "Patients can take the supplement either orally or vaginally."

Another option OB/GYNs are investigating is the placement of a pessary, a device typically used in pelvic organ prolapse patients to hold the uterus, bladder and other organs in place. "There's not a lot of strong data," says Rankins, "but we're hoping this is something we can offer in the future as an option."

Cervical incompetence can also lead to the baby being treated in utero: Because of the risk of preterm birth, OB/GYNs will sometimes prescribe a steroid to encourage more rapid development of the baby's lungs, increasing their chance of survival.

Premoli ended up delivering her daughter at 27 weeks. Her baby was taken to the NICU, where she stayed for the next two months while she stabilized and her parents learned to care for her at home. "They couldn't take the cerclage out, but she was trying to push her head down," says Premoli of the preterm birth."She came home at just under five pounds, but now she's a happy 3 year old."

"This is not your fault"

Rankins wants women to know that an incompetent cervix diagnosis "is not [their] fault."

"The word 'incompetent' is terrible, but please don't think that you're a failure or that this says something about you," she says. "Do not blame yourself."

While cervical insufficiency does mean a higher risk for preterm birth and pregnancy loss, it doesn't mean a woman won't be able to carry a pregnancy to full-term and deliver close to their due date. "Keeping your ultrasound and regular prenatal care appointments is crucial," reminds Rankins.

Rankins says it's important for doctors to be forthright and truthful with their patients about this important condition. "There's not really a better way to frame it, unfortunately," she says, "but I do think that doctors need to be clear that just because your body has this particular structure, it's not a reflection of you or your ability to have a child."

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