What Is Incompetent Cervix—And How Do You Determine if You Have One?

The facts about this “horribly named” condition from doctors and a woman who experienced it.

Carolyn Spiro-Levitt’s journey into motherhood took an unexpected and heartbreaking turn when she was around 18 weeks pregnant. What initially seemed like routine discomfort during pregnancy escalated into a devastating diagnosis of an incompetent cervix (IC) during her 20-week anatomy scan on June 15, 2020. This diagnosis altered the course of her pregnancy, leading to profound emotional turmoil and an urgent need for medical intervention.

Incompetent cervix, as meticulously defined by the highly esteemed Mary Jane Minkin, MD, a distinguished clinical professor of obstetrics affiliated with the Yale University School of Medicine, represents a medical condition characterized by the premature dilation of the cervix during pregnancy, usually unfolding devoid of the telltale signs of pain or contractions. It is particularly noteworthy that this distressing phenomenon tends to manifest itself during the pivotal middle trimester of pregnancy, spanning the second and third months. This specific timing introduces a profound and intricate challenge into the lives of expectant mothers, much akin to the poignant journey undertaken by Carolyn Spiro-Levitt herself.

The news of her diagnosis shattered the hopes and dreams of Spiro-Levitt and her husband, Josh. She expressed the anguish of her situation, lamenting that her baby was perfectly healthy, but her body could not sustain the pregnancy. The term “incompetent cervix” itself carries a weight of its own, being an outdated and somewhat misleading description of the condition. Dr. Minkin highlighted the importance of understanding that IC involves the cervix opening prematurely without accompanying contractions, emphasizing the need for clearer terminology.

One of the most challenging aspects of IC is the lack of a definitive cause. Rebecca C. Brightman, MD, a gynecologist in New York City, explained that while some women may have congenital weaknesses in their cervix, others develop IC without identifiable risk factors. Exposure to diethylstilbestrol (DES), a synthetic hormone used in the past to prevent miscarriages, can increase the risk of IC. Additionally, underlying connective tissue disorders, previous second-trimester pregnancy terminations, and cervical procedures like LEEP or cone biopsy may contribute to IC development.

The consequences of IC are heart-wrenching, with the primary risks being severe prematurity or fetal loss. For Spiro-Levitt and her husband, the day of her 20-week scan brought the terrifying realization that they faced a high risk of losing their baby. In a desperate attempt to save their child, they opted for an emergency cerclage, a procedure involving the placement of a suture around the cervix to keep it closed. However, the uncertainty loomed, and Spiro-Levitt had to endure strict bed rest for several weeks. On the night of July 5, 2020, contractions signaled the end of their agonizing journey, and their son, Eli Parker Levitt, entered the world but tragically passed away within 15 seconds.

Dr. Brightman, a seasoned medical expert in the field, elucidated the intricate nuances surrounding procedures such as LEEP (Loop Electrosurgical Excision Procedure) and cone biopsy. These interventions, typically undertaken to combat cervical pre-cancer and cancer following abnormal Pap smears, were acknowledged as potential contributors to the gradual weakening of the cervix over time. Nevertheless, Dr. Minkin, renowned for her extensive knowledge and expertise, offered a reassuring perspective by pointing out that while these procedures might indeed pose a certain risk factor, they seldom culminate in the development of IC.

The vigilance of medical professionals in meticulously monitoring the cervix during pregnancy emerged as a pivotal component of safeguarding maternal and fetal health. This thorough assessment of the cervix’s condition, executed through a combination of physical examinations and ultrasounds, underscored the healthcare community’s commitment to preemptively identifying any concerns or abnormalities. This proactive approach to cervical health management during pregnancy exemplified the dedication to ensuring the well-being of expectant mothers and the safe progression of their pregnancies.

The profoundly emotional and heart-wrenching experience Spiro-Levitt endured served as a catalyst, igniting an unwavering passion within her to become a tireless advocate for raising awareness about the often overlooked condition, IC. She harbored a profound desire for more women to be equipped with knowledge about this ailment, as she herself had been completely unaware of its existence until her own diagnosis blindsided her. Spiro-Levitt tirelessly emphasized the paramount importance of recognizing subtle yet crucial symptoms, such as pelvic pain or pressure, which can serve as early warning signals heralding potential IC-related complications on the horizon. Her fervent belief in the power of early detection through vigilant cervical checks or ultrasounds underscored her conviction that timely medical interventions could be the lifeline that makes all the difference in safeguarding the well-being of expectant mothers and their unborn children.

Furthermore, Spiro-Levitt passionately urged women to proactively advocate for themselves and engage in open, candid conversations with their healthcare providers. The journey of pregnancy can undoubtedly be a fragile and uncertain period, where placing trust in one’s instincts and promptly seeking medical attention if any concerns arise can undeniably play a pivotal role in effectively managing the challenges posed by an incompetent cervix.

In summation, Carolyn Spiro-Levitt’s personal odyssey through pregnancy while grappling with an incompetent cervix serves as a poignant and stirring reminder of the daunting obstacles that certain expectant mothers encounter. Her unwavering resolve to raise awareness, candidly share her own narrative, and fervently champion early detection and timely intervention in cases of IC stands as a remarkable testament to her exceptional resilience and boundless compassion. As the knowledge surrounding the risks and telltale signs associated with IC spreads, women will be better equipped to safeguard their pregnancies and secure the well-being of their future families.