Cervical insufficiency

Dr. med. Mira Seidel is a freelance writer for the medical team.

More about the experts All content is checked by medical journalists.

A cervical insufficiency (cervical weakness, cervical weakness) means that the cervix (cervix) is softer and shorter and thus the cervix opens earlier during pregnancy. Cervical insufficiency is an important cause of premature birth. It can be determined with an ultrasound scan. In some cases, surgery (cerclage) is recommended as therapy. Find out everything you need to know about cervical insufficiency here!

ICD codes for this disease: ICD codes are internationally recognized codes for medical diagnoses. They can be found, for example, in doctor's letters or on certificates of incapacity for work. O34N88

Cervical Insufficiency: Description

With a cervical insufficiency, the cervix (cervix) and the cervical canal (cervical canal) change. A progressive pregnancy can no longer be held sufficiently by the weakened occlusive apparatus. The cervix opens before the 37th week of pregnancy.

Every year, an average of one in 100 women develops cervical insufficiency. Pregnant women over the age of 35 are more often affected.

The cervix is ​​usually about three inches long and made of strong tissue. In the case of cervical insufficiency, it is shorter - the cervical canal becomes softer and the cervix eventually opens up to two to three centimeters.

Cervical Insufficiency: Symptoms

Symptoms of cervical insufficiency can differ, and they are often absent entirely. Some women experience menstruation-like pain and a feeling like their stomach is contracting. Furthermore, pressure downwards or pulling above the pubic bone or in the back and in the groin can occur. The normal contractions during pregnancy can express themselves in a similar way.

The cervical insufficiency must be distinguished from the contraction-related cervical shortening. In cervical insufficiency, the cervix usually opens symptom-free, without pain or labor. In the case of premature labor that begins before the calculated due date, on the other hand, the smooth muscles of the uterus contract, so that the cervix expands and the cervix opens.

Cervical Insufficiency: Causes and Risk Factors

There are various causes of cervical weakness: infections, multiple pregnancies and previous operations in the area of ​​the cervix or cervix are typical risk factors. A general weakness of the connective tissue can also promote cervical insufficiency.

Weakness of the cervix after infections

Cervical insufficiency can be caused by inflammation of the vagina and cervix. When infected, the body releases inflammatory messengers, so-called prostaglandins. They cause the cervix to shorten and open.

Weakness of the cervix in multiples

Multiple pregnancies can also be the cause of cervical insufficiency. The greater volume and weight of the uterus exerts greater pressure on the cervix, which overloads and weakens it.

Weakness of the cervix after operations

A previous operation such as a so-called conization to treat a preliminary stage of cervical cancer can also be a risk factor for cervical insufficiency. A flat cone of tissue is removed from the cervix. The deeper and larger the conization, the greater the risk.

Other important risk factors for cervical insufficiency are:

• Previous late miscarriages, premature births, previous cervical insufficiency or silent opening of the womb without bleeding
• ascending infections by chlamydia, gonococci, Garnerella vaginalis
• Rupture of the bladder before the 37th week in a previous pregnancy
• Bleeding
• Smoking - this inhibits enzymes that disrupt the build-up of connective tissue

Cervical Insufficiency: Examinations and Diagnosis

If there are any signs of cervical insufficiency, as with all abnormalities during your pregnancy, you should immediately consult a specialist in gynecology and obstetrics. To diagnose cervical insufficiency, the doctor will ask carefully about the symptoms and your history. Typical questions from the doctor would be:

• Do you have pain? If so, since when and how often has the pain started?
• Have you noticed any other peculiarities during pregnancy such as increased lower back pain or abdominal discomfort?
• How many pregnancies and births have you had?
• Have you previously had miscarriages in a late pregnancy and did the cervix open painlessly without labor?

A vaginal examination will now determine whether your symptoms are normal pregnancy labor or cervical insufficiency. If the doctor suspects cervical insufficiency, he will perform an ultrasound scan of the cervix.

In the case of cervical insufficiency, the shortened cervix and the open cervix can be clearly seen. The cervical canal can be shaped like a funnel. In some cases, the amniotic sac can advance into the vagina.

Cervical insufficiency means an increased risk of premature birth. Short-term, regular checks are particularly important for pregnant women with known risk factors.

Cervical Insufficiency: Treatment

Cervical insufficiency must be treated to prevent the risk of premature birth. If this is already threatening, one tries to extend the pregnancy by at least 48 hours. This saves time to transfer the affected person to a premature baby special center and to accelerate the lung maturation of the fetus with medication. Both measures significantly increase the chances of survival of premature babies before the 34th week of pregnancy.

Physical relief - bed rest

When the baby is born prematurely, the focus is on rest: the person affected should be admitted to the hospital and be kept in strict bed rest. A side position with a raised pelvis is recommended. Avoid physical exertion and refrain from nicotine - nobody should smoke in your surroundings either.

Antibiotic treatment for infection

If an infection is suspected, a vaginal smear is taken. If necessary, it is treated with an antibiotic. Thorough intimate hygiene is also important. Avoid wearing insoles.

In the case of a premature birth with premature rupture of the bladder, evidence of inflammation is also looked for. Because there is always the risk of an infection of the fetus in the uterus (intrauterine infection). The doctor takes blood to check CRP, white blood cells and the differential blood count. Body temperature should be measured regularly. Based on the findings, the doctor decides whether the child can first wait for the lungs to mature or whether premature birth is the lower risk.

Tokolysis - drug inhibition of labor

In some cases it is necessary to use medication to prevent labor. The process is called tocolysis. For this, the person affected is given a so-called betamimetic via the vein, which slows down the activity of the muscles of the uterus. However, a pregnancy can only be extended by a few days in this way.

After the 34th week of pregnancy, tocolysis is usually no longer performed because the child is sufficiently mature and has a very good chance of survival. Labor activity and the child's vital functions are regularly monitored by CTG (cardiotocography) and ultrasound examinations.

Cerclage and complete closure of the cervix

A so-called cerclage can be performed as a surgical measure in the case of cervical insufficiency in the first or second trimester of pregnancy. In the case of cerclage, a plastic band is placed around the cervix under general anesthesia to provide mechanical support and to keep it tight. The cerclage is only removed shortly before delivery.

If the amniotic sac has already fallen into the vagina, a cerclage may be the only way to prolong a pregnancy. One then speaks of an emergency cerclage.

A cerclage is controversial and, in the opinion of the specialist societies, its benefit has not been proven beyond doubt. Cervical insufficiency due to infection can pose an additional risk.

Sometimes complete occlusion of the cervix is ​​recommended. The external cervix is ​​sutured in order to create a barrier against microorganisms and thus prevent an ascending infection.

Cervical insufficiency: disease course and prognosis

If left untreated, cervical insufficiency can lead to late miscarriage or premature birth. The risk of premature birth in another pregnancy is also increased.

Cervical Insufficiency: Prevention

There is no reliable prevention of premature birth in cervical insufficiency. However, there are a few things you can do to reduce your risk of premature birth:

• Eliminate nicotine altogether
• Try to get a grip on being severely overweight or underweight with the help of nutritional advice
• Do you have a very stressful job, physically or emotionally? As a precaution, a physical or even employment ban can be prescribed.

It is important to identify pregnant women at an increased risk of cervical insufficiency at an early stage in order to prevent the risk of premature birth.

Tags:  prevention pregnancy elderly care