Cervical incompetence or weak uterus during pregnancy, what is the cause?

A strong and healthy uterus is needed to support fetal growth and development for 9 months. But according to American Pregnancy, about 1 in 100 pregnant women have a weak uterus. The medical term for a weak uterus is cervical incompetence.

This condition is a pregnancy complication that can have serious consequences. When the uterus is weak, the risk of preterm labor, the baby is stillborn (stillbirth), and miscarriages in the second trimester will increase.

What is cervical incompetence?

The cervix is the cervix that connects the vagina with the uterus. Before becoming pregnant, the cervix is normally closed and stiff.

As you get older, your cervix will slowly soften and shorten until it finally opens up in preparation for delivery. The cervical opening will allow the baby to come out to be born into the world.

On the other hand, the baby's weight will also continue to increase, thus pressing on the cervix. The greater pressure over time can cause the cervix to open more quickly, even before the baby is really ready to be born. This is the cause of a weak uterus, aka cervical incompetence.

Weak uterus cannot be known before a certain gestational age. This condition usually occurs in the second trimester of pregnancy to the end of the third trimester.

If you have had cervical incompetence, then your uterus is at risk of returning to weakness in your next pregnancy.

If you are considering trying to get pregnant again, talk to your obstetrician about the risks and treatments that can be taken during pregnancy.

What are the causes of cervical incompetence?

Apart from the influence of the baby's weight, which is pressing on the uterus for a long time, the following factors can also increase the risk of a weak uterus, namely:

Have had surgery in the cervical area, such as the LEEP procedure (Loop Electrosurgical Excision Procedure)
Have had one or more previous preterm births
Have a history of cervical trauma, for example, have had a curette due to a miscarriage or an abortion.
Having uterine abnormalities. Uterine disorders and genetic disorders that affect collagen production can cause cervical tissue to weaken.
Taking the drug DES (Diethylstilbestrol), a synthetic hormone therapy during pregnancy.
Damage to cervical tissue during difficult childbirth.

Amniotic fluid infection is also one of the risk factors for a weak uterus that must be watched out for so that your pregnancy is not interrupted.

Symptoms and signs of cervical incompetence

A weak uterus generally shows no significant symptoms. In most cases, the following are symptoms and signs that you need to watch out for as reported by the Mayo Clinic:

The pelvis feels sore from the immense pressure
Back pain
Mild stomach cramps
Changes in vaginal discharge (can be white, yellow, or brown in color)
Stained blood from the vagina for several days.

Symptoms of cervical incompetence or uterine weakness usually occur between the fourteenth to the 20th week.

However, every pregnant woman has different conditions so that the symptoms that appear may be different. So, if you feel one or more of the disorders above, do not hesitate to consult a doctor immediately.

How do doctors diagnose cervical incompetence?

Examination of the uterus is weak due to cervical incompetence not a major part of routine uterine checks. Usually this condition is not diagnosed until a miscarriage occurs in the second or third trimester.

However, some medical tests performed before pregnancy can help detect uterine abnormalities that may be the cause of cervical incompetence or uterine weakness.

If you are not pregnant yet but are at high risk of experiencing a weak uterus, consult your doctor for a detailed examination.

Examination procedures such as hysterosalpingography, ultrasound, or MRI scans can tell the doctor how well the uterus, fallopian tubes, length of the cervix, and the surrounding area are doing.

During your second trimester, it's a good idea to request a transvaginal ultrasound, pelvic exam, or amniotic fluid sample to make sure you don't have risk factors for uterine weakness or cervical incompetence.

Care and medication to treat cervical incompetence

Cervical incompetence can cause pregnant women to miscarry or give birth to premature babies. To prevent this complication, the way of treatment or treatment will be based on the causes and risk factors that you have.

1. Hormone injection

If you have a history of preterm birth, your doctor will likely recommend injections of the hormone progesterone during the second trimester. This aims to strengthen the cervical and uterine tissues so that cervical incompetence does not occur.

However, you need a thorough consultation to determine whether this step is right for your condition. Progesterone injections are usually not always effective in all cases of cervical incompetence, especially if the mother is carrying twins or more.

2. Tie the cervix (cervix cerclage)

If your cervix starts to open up or becomes shorter than it should be, your doctor will recommend a further procedure called cervix cerclage.

Prior to doing this procedure for cervical incompetence (weak uterus), your uterus will be monitored by a doctor using ultrasound at each examination.

Ultrasound is useful for checking the length of the cervix, done every two weeks from the 15th week to the 24th week.

The cervical tie procedure is performed by inserting an instrument called a speculum into the vagina. When inserting this instrument, a speculum is inserted together with the ultrasound to clearly see which part of the cervix will be tied and sutured.

After the suture procedure due to cervical incompetence is complete, usually the doctor will perform another ultrasound examination to check the condition of the baby in the womb.

The effect is, a few days after undergoing the uterine binding procedure, pregnant women may experience blood spots, cramps, and pain when urinating.

It should be noted, after undergoing this procedure to overcome cervical incompetence you should not have sex first for a week.

This aims to ensure that the vagina and cervix have recovered from the trauma. However, cervical suturing is not recommended for women who are pregnant with twins.

3. Rest at home

In addition to medication and medical treatment, you will also be asked tobed rest or resting at home while pregnant. The goal is that you do not have physical activity that is too burdensome for the womb and can further weaken your cervix.

If you have cervical incompetence (weak uterus), you may also be advised to stop having sex for a while or it may continue for the rest of the pregnancy, depending on your condition.

Can it prevent the uterus from weakening?

Most cases of weak uterus (cervical incompetence) are influenced by genetic factors, so it is difficult for you to completely prevent cervical incompetence.

However, there are a number of things you can do to keep your pregnancy healthy until the birth arrives, including:

Routinely undergoing pregnancy checks
Maintain a healthy diet during pregnancy (especially meet the intake of folic acid, iron, and calcium)
Take pregnant vitamins
Routine light exercise to maintain a healthy body weight

You also need to avoid exposure to harmful chemicals that can increase pregnancy complications and lead to fatal consequences, such as alcohol and cigarettes.