Endocrine Regulation of Cervical Functions During Pregnancy and Labor
Gabor Huszar in The Physiology and Biochemistry of the Uterus in Pregnancy and Labor, 2020
Early pregnancy loss in most instances is not related to an abnormality of cervical maturation. The entity of cervical incompetence is the exception to this statement. Cervical incompetence is a failure of the cervix to perform its function as a protective barrier. It is a difficult state to define clinically and probably has several etiologies. Among these are previous cervical lacerations or trauma, premature induction of parturitional changes of a normal cervix, and an intrinsic defect in cervical composition. All of these could compromise the structural integrity of the cervix leading to premature effacement and dilatation. Cervical cerclage procedures have proven to be a moderately effective therapy, but future therapies may require a more specific appreciation of the abnormality, which is causing cervical incompetence, and may include biochemical manipulation to maintain or reestablish the physical integrity of the cervix as a barrier.
Causes and risk factors
Janetta Bensouilah in Pregnancy Loss, 2021
Also termed cervical insufficiency, cervical incompetence is well recognised as a potential cause of mid-trimester miscarriage, and although some cases involve mechanical weakness, in the majority of cases there is normal cervical anatomy, but evidence of subclinical intrauterine infection. However, whether infection is the result or cause of premature cervical dilation remains unknown.10 In addition to being a congenital problem, cervical incompetence may follow mechanical trauma such as excessive dilation at the time of curettage, cervical biopsy or occasionally a difficult vaginal delivery. Preterm labour (PTL) has been linked to cervical incompetence in single and multiple pregnancies. In the case of the latter, the risk is higher, and as PTL is the major cause of neonatal death in multiple pregnancies, cervical screening is useful for identifying those at risk, although there is uncertainty as to whether the standard treatment of inserting a stitch (cerclage) improves pregnancy outcome.12,13
Miscarriage
Jane M. Ussher, Joan C. Chrisler, Janette Perz in Routledge International Handbook of Women’s Sexual and Reproductive Health, 2019
Depending on the gestational stage, miscarriage may be prolonged, painful, accompanied by large blood loss and perhaps the sight of the products of conception, and may be experienced as frightening or even traumatic (Bellhouse, Temple-Smith, Watson, & Bilardi, 2018; Wojnar, 2007). An “incomplete” miscarriage occurs when tissue is retained in the uterus that can lead to haemorrhage and infection. All miscarried pregnancies were once considered incomplete, and thus surgical curettage – evacuation of the uterus under general anaesthetic – was the treatment of choice. The procedure itself carries risks, including cervical trauma and subsequent cervical “incompetence,” preterm birth, uterine perforation, haemorrhage, and intrauterine adhesions (Lemmers et al., 2016; Nanda, Lopez, Grimes, Peloggia, & Nanda, 2012). However, ultrasound examinations indicate that only a proportion of miscarriages are incomplete; thus pharmacological treatments for incomplete miscarriage aimed at minimizing morbidity, mortality, and unnecessary surgical intervention can be used (Blum et al., 2007; Neilson, Gyte, Hickey, Vazquez, & Dou, 2013).
A retrospective cohort study of obstetric complications and birth outcomes in women with polycystic ovarian syndrome
Published in Journal of Obstetrics and Gynaecology, 2022
Qiwei Liu, Jingxue Wang, Qian Xu, Liang Kong, Jinjuan Wang
Chorioamnionitis was defined by 2 or more clinical signs of infection, including maternal pyrexia, tachycardia, uterine tenderness, offensive liquor and foetal tachycardia (Stojanovska et al. 2018). Cervical incompetence was diagnosed based on clinical symptoms and ultrasound results (Wang et al. 2016). The definition of cervical incompetence incorporates both a sonographic cervical length of less than 25 mm and prior spontaneous preterm birth at less than 37 weeks. The traditional management of cervical incompetence is application of transvaginal cervical cerclage. Non-invasive management options also exist, including progesterone therapy and cervical pessary, which may be effective management options. The diagnosis of preterm birth is defined as <37 weeks of gestation (Leonard et al. 2015).
Six-month recovery needed after dilation and curettage (D and C) for reproductive outcomes in frozen embryo transfer
Published in Journal of Obstetrics and Gynaecology, 2018
Kemal Ozgur, Hasan Bulut, Murat Berkkanoglu, Faruk O. Basegmez, Kevin Coetzee
Cervical dilation with suction or blunt curettage, commonly known as dilation and curettage (D and C), has been the procedure most often used to manage the retained products of conception (RPOC) after a miscarriage, with a high success rate (≈95%) (Lemmers et al. 2016). Although the D and C procedure is considered to be safe and simple to perform, it is associated with some physical complications, i.e. cervical damage, bleeding, infection, perforation of the uterus, bowel or bladder, scarring, intrauterine adhesions, as well as Asherman syndrome. In addition, D and C procedures per se have been reported to increase the risk of adverse perinatal and obstetric outcomes in terms of a preterm premature rupture of membranes, a preterm delivery, a very preterm delivery, and of pre-eclampsia during the subsequent pregnancies (Bhattacharya et al. 2012; Mannisto et al. 2013; McCarthy et al. 2013; Lemmers et al. 2016). The main pathophysiological mechanisms involved in these adverse reproductive outcomes are believed to include cervical incompetence as the result of cervical dilatation and endometrial damage as the result of curettage.
Clinical factors associated with pregnancy outcome in women with recurrent pregnancy loss
Published in Gynecological Endocrinology, 2019
Maho Miyaji, Masashi Deguchi, Kenji Tanimura, Yuki Sasagawa, Mayumi Morizane, Yasuhiko Ebina, Hideto Yamada
Table 2 shows clinical factors and pregnancy outcome of women with RPL. Twenty-one women with uterine abnormalities included six with septate uterus, two with arcuate uterus, one with bicornuate uterus, one with unicornuate uterus, seven with adenomyosis and/or myoma uteri, and four with cervical incompetence. Six women with uterine abnormalities underwent a surgical operation prior to the conception. Four women with septate uterus underwent hysteroscopic metroplasty, one woman with myoma underwent hysteroscopic myomectomy, and one woman with myoma underwent hysteroscopic and abdominal myomectomy. Two women with cervical incompetence underwent cervical cerclage early in pregnancy. Twenty-one women with thyroid dysfunction included 10 with hypothyroidism and 11 with hyperthyroidism.
Related Knowledge Centers
- Cervical Conization
- Cervical Dilation
- Miscarriage
- Cervix
- Uterine Contraction
- Preterm Birth
- Pregnancy
- Cervical Effacement
- Recurrent Miscarriage
- Cervical Canal