Cervical insufficiency – colloquially called cervical weakness – (synonyms: isthmocervical insufficiency, incompetent cervix, cervical insufficiency, cervical incompetence, ICD-10-GM O34.3: maternal care in cervical insufficiency) is a functional defect of the cervix (uterine neck). It is a condition with premature cervical shortening or cervical opening during pregnancy with concomitant centering, softening, and opening of the cervix or cervical canal (uterine canal) independent of labor or other causes, the result of which is late abortion or preterm delivery.
The point of reference is the stability, functional capacity or competence or instability, functional incapacity or incompetence of the cervix. It is thus one of the decisive causes of late abortion (miscarriage in the period from the 13th to the 24th week of pregnancy (SSW)) or preterm birth, along with premature labor. Whereas in the past the diagnosis could only be made post partum (after birth) as an anamnestic criterion, since palpation findings (tactile findings) and condition after cerclage (surgical closure of the cervix) are not reliably comparable parameters, today vaginal ultrasound (ultrasound in which the transducer is inserted through the vagina) is a major advance in functional diagnostics. The assessment is no longer as dependent on the examiner as, for example, palpation (palpation). The cervical length and, above all, the width of the inner cervix can be assessed in a reproducible manner. Therapeutically decisive is also the assessment of the course of the disease.
The incidence (frequency of new cases) is not precisely known because of the extensive subjective diagnostic and anamnestic uncertainties. It is currently estimated to be 0.5-2%.
The course and prognosis depend on mostly unknown variables (e.g., latent (“hidden”) ascending infections, genetic or pregnancy-related connective tissue changes of the cervix, humoral or hormonal situation) and therapeutic measures (e.g., cerclage/cervical wrap, tocolysis/anti-retention).
