Cervical Incompetence

Definition

Cervical dilatation in the absence of any abdominal pain

Causes

• Cervical dilatation during termination of pregnancy
• Cone biopsy of the cervix (for suspected cervical cancer/neoplasia)
• cervical amputation during Manchester repair for uterine prolapse
• Exposure to DES (di-ethyl-stilboestrol)- a synthetic oestrogen drug that was prescribed up until the mid 70s.
• 25% of cases are idiopathic

Management

• Cervical cerclage
  • Shirodkar’s or McDonald’s suture usually performed at 14 weeks gestation.  There is a small risk of rupturing membranes and infection.  The stitch is then removed at 36 weeks or at labour (whichever is earlier).