Uterine Cervical incompetency -Symptoms, cause and treatment

Uterine Cervical incompetence is a condition in which cervix dilates with out causing pain causing delivery of premature fetus. Delivery occurs when the membranes ruptures. Thus cervical incompetence is a condition in which a cervix that is abnormally weak dilates and leads to miscarriage. Miscarriage occurs usually in a period of 16 to 24 weeks with out any prior symptoms like pain.

Symptoms

Usually there are no symptoms and at times there might be back pain, heavy vaginal discharge, little or no bleeding with or with out pain. Pain occurs with miscarriage only and not in prior stage.

Cause

Injuries caused during previous deliveries, previous D&C or scraping of tissues inside uterus, cervical surgery, uterine abnormalities etc can lead to cervical incompetence. But the cause for disease is not known. DES exposure, cervical trauma, hormonal problems, congenitally chort cervix etc are also causes.

Treatment

Usually stitch is done to make cervix firm. This is done during pregnancy. This method of stitching the cervix is known as cerclage. This is done during 14thto 16th week. It is better to do cerclage as earlier as possible for pregnancy to continue. But a ppatient with hyperirritability of cervix can not perform cerclage. If the dilation is more than four centimeters or if the baby is dead, if the water is broken cerclage can not be done.

There are mainly five methods of putting stitch. Most popular are McDonald and Shirodkar method. In all five methods spinal anesthesia is given to reduce pain. In McDonald method a 5mm permanent stitch is put on high cervix. Stitch is removed in 37 weeks. If there is any infection or preterm labor, rupture of membranes etc stitch is removed earlier. This is the most effective method.

Usually Shirodkar method is used mostly. In this method a cesarean is to be performed for delivery. A permanent stitch is put for life long in this method and that is why cesarean becomes necessary.

Another method is Hefner cerclage in which a U or mattress stitch is put which is useful to prevent minimal amount of cervix left. Method is also known as Wum procedure.

Uterosacral cardinal ligament cerclage is done after failure of McDonald or Shirodkar. It is otherwise useful when there is congenital shortened cervix or subacute cervix. It can be done abdominally as usual or vaginally. In this case also a cesarean is necessary for delivery.

Lash is done when the disease is detected before pregnancy. Usually it is done after cervical trauma that led to an anatomical defect. It might cause infertility.

But all these methods are not 100% successful. There are possibilities of premature rupture of membrane, infection to amniotic sac or Chorioamnionitis, bladder injury, uterine rupture, cervical dystocia, maternal hemorrhage, preterm labor, cervical laceration or amputation etc.

Links

http://www.ncbi.nlm.nih.gov/pubmed/4919334?dopt=Abstract

http://pregnancy.about.com/cs/incompetentcervix/a/aaincomp.htm