An Incompetent Cervix – What it Means and When to Worry

incompetent cervix

When I found out I was expecting twins, one of the things I just naturally started to prepare for was that they would come before their due date. What I wasn’t expecting was just how early they would be and the reason they would ultimately end up being so early. I honestly had an uneventful first half of my pregnancy. Aside from the initial surprise of finding out we were expecting identical twins, I felt pretty good, continued to exercise, and was excited about preparing for the babies.

After weeks of growing more pregnant and excited for the opportunity to see our babies, it was time for the 20-week ultrasound. Our sonographer started by taking a look at my cervix and that’s pretty much where it ended. Since she didn’t like what she saw, she immediately stopped the ultrasound to go talk with my obstetrician. He referred me to a perinatal center in a larger city, one that was at a hospital with a Level IV Neonatal Intensive Care Unit. Two days later, my husband and I finally got to see the full ultrasound of our babies, although it was definitely a much more stressful appointment than our first attempt. After the full anatomical ultrasound was over, it was time to talk to the doctor. Our perinatologists saw the same cervical changes – funneling and some thinning (effacement). They seemed less alarmist than our obstetrician, explaining that these changes sometimes happen in twin pregnancies. The plan? To come back in a couple weeks and do another transvaginal ultrasound to check my cervical length again. I did have to make some changes in the meantime. There would be no more exercising or long walks. I was able to continue working, but told to take it easy. I also had a baby shower scheduled back in our hometown a week later, but the idea of travel was now off the table. (We thankfully were able to Skype.)   

incompetent cervix

About two weeks later, we were back at the perinatal center for that follow-up cervical ultrasound. At this appointment, we found that my cervix had effaced even more and was possibly dilated (it seemed like it was so early in the dilation process that it depended on who was checking it). We were sent to the hospital so that I could be triaged and monitored. I was 22 weeks and 6 days pregnant. (We would later be told the earliest viability for our twins would be 23 weeks.) I was given the option of going home (nearly 2 hours from this hospital and its level IV NICU) or being admitted and staying on hospital bedrest for the indefinite future. It was an easy decision to make, as it was highly unlikely I would be able to make it back to that hospital to deliver if I went into labor, not to mention the babies were so small and fragile, they needed to be as close as possible to the NICU. The doctors inserted a pessary (at the time, cerclages were not done to twin moms at my hospital) and I spent the next five weeks on hospital bedrest. My team did weekly ultrasounds, to check on my cervix and make sure the twins continued growing well. Nothing noticeably changed while the pessary was in place and everything stayed stable, we even discussed me being discharged. I ended up having some contractions and going into labor while I was still in the hospital, just days before I was supposed to be heading home to finish up my bedrest. My identical twin girls were born at 28 weeks, but that’s a story for another day.  

All throughout these appointments and my hospitalization, I never had any contractions picked up on the monitor, the only problem seemed to be my cervix. The doctors call this cervical insufficiency, also known as an incompetent cervix. When you think about a typical delivery, the cervix both effaces (thins) and dilates (opens) leading up to or during labor, often assisted by contractions. Women with cervical insufficiency experience painless cervical effacement and dilation, they do not even realize that it’s happening. Having had this stressful experience with premature effacement and cervical insufficiency during my twin pregnancy, I learned there was very little I was actually in control of, aside from doing my best to stay relaxed and in bed. I found that “googling” my situation helped me to feel empowered with knowledge and I found peace in knowing that I was doing all I could do to help my babies grow.

I was very fortunate that the effacement began so close to my 20-week ultrasound, so that my medical team was able to catch it, monitor the changes, and come up with a plan to keep me pregnant for as long as possible. It seems that, though there can be some contributing factors, women are not usually assessed for a premature effacing cervix, unless there is a history of preterm birth. Premature effacement, if it happens early enough in pregnancy, can lead to second-trimester pregnancy loss. If you’re concerned about effacing early in your multiple pregnancy, talk with your doctor so that you can get information on your specific situation and make a plan, if needed. My husband and I have just started wrapping our heads around the possibility of having another child and the first appointment we made was to sit down with our perinatologist and discuss our concerns about cervical insufficiency and another early effacement/dilation. If I am able to get pregnant again, we’ll begin going back to our perinatal center for transvaginal cervical ultrasounds starting at 16 weeks, so that our team can closely monitor any cervical changes.

incompetent cervix

Photo Credit: Jane Goodrich Photography

If you’re reading this and are dealing with effacing early during your multiple pregnancy, please remember that you did nothing to cause this! It can be so hard to not feel guilty, but the best thing you can do is to work with your medical team to make a plan, take it easy, and do whatever helps you stay relaxed.

All content on this Web site, including medical opinion and any other health-related information, is for informational purposes only and should not be considered to be a specific diagnosis or treatment plan for any individual situation. Use of this site and the information contained herein does not create a doctor-patient relationship. Always seek the direct advice of your own doctor in connection with any questions or issues you may have regarding your own health or the health of others.

Heather Patel lives in the Finger Lakes of New York with her husband, 2.5 year old identical twin girls, and their rescued lab mix. A former special education teacher, she is enjoying her new role as a stay-at-home mom. So far, her first experience as a mother has included surviving hospital bedrest, delivering 28 weekers who had a nearly 3 month NICU stay, and raising twins with developmental delays. She also looks forward to passing on her love for the outdoors, photography, and DIY to her girls.

 


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