As a baby grows during pregnancy, the heavier weight of the baby presses on the cervix, and the added pressure may cause the cervix to open before birth. In a normal pregnancy, the cervix is supposed to widen as a woman carries a baby to term. But in some cases, the cervix begins to grow wider (dilate) and become thinner (efface) too early in the pregnancy. The condition, known as incompetent (or weakened) cervix, can lead to premature delivery of the baby or even a second or third trimester miscarriage. This condition happens in 1 out of 100 pregnancies, and of all babies miscarried in the second trimester, about 25 percent are due to a weakened cervix.
It is very important to note that doctors do not routinely check for incompetent cervix during pregnancy, so unfortunately, women typically miscarry in the second or third trimesters, and only then is the condition diagnosed.
A woman can request an examination by her doctor, who can perform the exam either before pregnancy or in early pregnancy. The doctor will perform a pelvic exam or do an ultrasound, or perhaps might administer both procedures. The pelvic exam allows the doctor to visually and manually inspect the cervix, while the ultrasound is used to measure both the opening and length of the cervix to check for any issues. It is particularly important for a woman to ask her doctor for this exam if she has any of the risk factors listed below.
There are several causes of the incompetent cervix condition. Women may be at risk if they’ve previously had surgery on the cervix, or have had damage during a difficult previous birth. Women who have had a procedure called a D&C (dilation and curettage) from a previous abortion or miscarriage could also be at risk. Some women can have a malformed cervix birth defect. Finally, if a woman has been exposed to a chemical called diethylstilbesterol (DES), this can also put her at risk. Diethylstilbestrol (DES) is a synthetic estrogen hormone prescribed to pregnant women between 1940 and 1971. It was used at the time to prevent miscarriage, premature labor, and other pregnancy complications. Use of the drug stopped in the United States in 1971 when researchers linked DES to a type of cervical cancer. DES prescriptions were halted in Europe in 1978. The risk is not only to women who took DES, but also to their daughters.
The daughters of women who used DES while pregnant have a 40-times greater risk of developing cervical cancer and may have abnormal cells in the cervix which may lead to weakening during pregnancy. If a doctor is aware of a woman’s risk factors but does not adequately monitor the condition and provide treatment, then the doctor may be responsible for any resulting injury to the mother or fetus.
If a doctor diagnoses incompetent cervix, the treatment is a procedure called cerclage to sew (suture) the cervix closed to provide reinforcement during the pregancy. Doctors usually perform the surgery during weeks 14-16 of pregnancy, and remove the sutures at 36-38 weeks so that problems are not encountered if a woman goes into labor. Doctors usually won’t perform the cerclage procedure if the cervix is irritated or if it is dilated to 4 cm or more.
Most doctors view cerclage as a life-saving procedure and therefore worth having despite the possible risks. But cerclage does have inherent risks and complications that women should be aware of. These include laceration of the cervix, rupture of the uterus or bladder, hemorrhage, or preterm labor. While the likelihood of these risks is very minimal, they can occur and may be caused by medical malpractice by the doctor or attending staff.
There are many potential risk factors for cervical insufficiency, including having cervical incompetence in a prior pregnancy. If a doctor is aware of risk factors and does not adequately monitor the patient and provide treatment if there are signs that the fetus might be affected, then the doctor may be responsible for the injury to the fetus resulting from cervical insufficiency. Cervical insufficiency can generally be treated, if treatment is needed, through a procedure called cervical cerclage to reinforce the cervix.
Unfortunately in some cases, treatments or procedures prescribed by doctors can cause the incompetent cervix condition. Many women need cervical biopsies for diagnostic reasons. The most common reason for a cervical biopsy is a finding of abnormal, questionable, or suspected pre-cancerous cells, discovered in a woman’s annual gynecological exam. In the annual exam, pap smears are routinely performed and the slides containing cells are sent to the lab. If suspect cells are found, a cervical biopsy is ordered. Doctors may use a specific type of cervical biopsy called conization to get a sample of precancerous cells. Unfortunately, the conization procedure can cause cervical weakening, because a cone-shaped or cylindrical wedge of tissue is cut from the cervix. If a doctor performs this procedure and fails to outline the risk factors, the situation could potentially be considered malpractice. In particular, if the doctor knows that the patient desires a pregnancy in the near future, this may be a strong case for potential malpractice.
Another cause may be a doctor’s use of procedures to “ripen” the cervix, but instead weaken the cervix. Sometimes in late (third trimester) pregnancy, a technique called mechanical dilation is used to stimulate the cervix to widen for labor. Unfortunately, it can lead to weakening of the cervix for the current pregnancy as well as subsequent pregnancies.
If a doctor has contributed to a cervical incompetence, it is important to consult with an experienced medical malpractice attorney for advice. A free legal review of your case for possible medical malpractice can be performed.