Bola has suffered back to back miscarriages in the past two years.
Now in another pregnancy, she resolved to do everything to ensure she carried it to term. Hence, she vowed to attend all antenatal visits, change environments, take time off from work and adhere to every health advice from her Obstetrician.
However, as she approached the 24th week of pregnancy, she saw spots of blood in her underwear and became alarmed.
Immediately she took herself to the hospital and the emergency physician on-call, got her medical history, even as she spoke in near-hysteria, and made suspicion of cervical insufficiency.
She then paged Bola’s Obstetrician and discussed extensively with him. When he arrived, they carried out more examinations and investigations and the diagnosis of cervical insufficiency was confirmed.
Cervical insufficiency or incompetence occurs when weak cervical tissue causes or contributes to premature birth or the loss of an otherwise healthy pregnancy. The cervix is the lower part of the uterus, and on which the head of the fetus.
Before pregnancy, the cervix is normally closed and firm. As pregnancy progresses and the delivery date is close, the cervix gradually softens, decreases in length and opens. If one has an incompetent cervix, the cervix might open too soon, and can cause a too-early birth.
Like the lady in the fiction above, symptoms begin to manifest between the 14th and 20th week of pregnancy, with symptoms in addition to light vaginal bleeding including backache, mild abdominal cramps, vaginal discharge and sensation of pelvic pressure.
Risk factors and exact causes of the insufficiency are usually not known, however, previous cervical trauma, being black and having uterine malformations can play a part.
Diagnosis can only be made during pregnancy as no tests have been designed to identify this outside pregnancy. The diagnosis is usually clinched from an in-depth medical history especially when there have been one or more previous spontaneous pregnancy losses, in addition to the symptoms described above.
Then, ultrasounds would be done, mostly transcervical ultrasound, to fully assess the state of the cervix, and then other laboratory tests as deemed fit by the obstetrician.
The commonest method of treatment is via surgery in a procedure known as a cervical cerclage, which aims to reinforce the integrity of the cervix and keep it in place till it’s safe to deliver the baby.
Sometimes, however, cervical insufficiency leads to an emergency premature delivery.
Reference:
Mayoclinic
