Sandhya and her husband are devastated. She has just miscarried for the third time. She had really hoped that things would go well in this pregnancy but at five months she expelled the baby. There was no pain at all. She just felt the water bag break and the next thing she knew, the baby was slipping out of her.

Sandhya has cervical incompetence , also known as cervical insufficiency. Luckily, this is a treatable cause of pregnancy loss. She has a good chance of having a baby if she undergoes the correct treatment.

Sumitra, however, was luckier. She had gone for a routine ultrasound in the fifth month of her pregnancy. During the ultrasound examination, the doctor found that the cervix was gradually opening up though she had no pains at all. Her obstetrician immediately saw her. An emergency procedure called cerclage was performed and she was able to carry the baby to full term.

What is cervical incompetence? 

One of the common causes of recurrent miscarriage is an incompetent cervix. In this condition the muscle fibres of the cervix (mouth of the uterus) are weak. In a normal pregnancy, the cervix stays closed and holds the baby in the uterus till labour starts at the end of the pregnancy. However, in cervical incompetence, once the baby reaches a certain weight, the cervix is not able to hold the baby and starts opening without any pain. This usually happens between the fourth and seventh month of pregnancy. The woman may feel some pressure in the lowest part of her abdomen, may have excessive mucous-like discharge and then if no treatment is given, loses the baby.

What causes cervical incompetence?

Sometimes there is no known cause for the cervical weakness. The weakness may be inherent in the cervix; in other words the woman is born with the weakness. In this situation, the problem may arise with the very first pregnancy. Occasionally it may occur after the woman has undergone surgery on the cervix. However, it is important to remember that if the problem arises in one pregnancy, all subsequent pregnancies will have the same problem.