Cervical insufficiency: Is it a good idea to exercise during pregnancy?

The cervix is a narrow passage (an opening), forming the lower end of the uterus (the womb), and most of us already know that it plays a critical role during pregnancy. Usually, it remains closed during pregnancy and doesn’t open up until the third trimester. But in those who suffer from cervical insufficiency, the cervix opens up earlier than expected, and can cause premature birth, membrane rupture, and in certain cases, miscarriage.

A little more about cervical insufficiency

The condition is not accompanied by contractions or pain. It is clinically defined as dilatation and shortening of the cervix, prior to the 37th week of pregnancy. Here are some signs and symptoms of cervical insufficiency you must know about:

* Cramps in the abdomen
* Spotting between 14-20 weeks of pregnancy
* Increase in pressure of the pelvic area
* Vaginal bleeding
* Certain normal physiological symptoms during pregnancy.

What are the causes of cervical insufficiency?

Some acquired causes include previous abortion, other cervical procedures, or previous C section. There could be other congenital causes like collagen vascular disorders, short cervix, or in utero exposure to diethylstilbestrol (hormone given to some women to conceive.)

Prevention and diagnosis of cervical insufficiency

There is no particular diagnostic test that has been shown to be successful in diagnosing cervical insufficiency. However, there are a few tests that can help to detect the signs or symptoms which include transvaginal ultrasound cervical length < 25 mm3 in the first trimester, history of spontaneous preterm birth, and/or physical examination, revealing cervical changes, or preterm birth at 14 to 36 weeks.

There is a lack of evidence on the prevention of cervical insufficiency. Preventing trauma to the cervix is the first strategy that could be applied to prevent cervical incompetency.

Medical management of cervical insufficiency

Cerclage is a procedure that uses a single stitch around the cervix to help prevent preterm birth or miscarriage. It is successful in 85-90% of the cases. In some cases, a medical device called a cervical pessary is placed at the opening to the cervix to close it. It is removed in the third trimester.

Progesterone is an important hormone that prepares your body for pregnancy. So, doses of this hormone are thought to be helpful to prevent premature birth.

Are there any recommendations for exercise?

There are few studies that reported a lower incidence of preterm delivery among exercising women. Recent evidence suggests exercising for 20 minutes >= 2 days is shown to be safe. It is found that physically demanding work such as repetitive lifting and heavy load carrying manual labour, or significant physical exertion increases the risk of premature birth.

In a study, some occupational exposures like standing, lifting, shift work, prolonged work hours, and their effects on preterm birth were studied. However, they found no significant relation between these factors. So, no work activity restrictions were justified in patients, who had previous premature births.

For women who had a previous preterm birth, recommended activities included walking, stationary cycling, swimming, modified yoga, Pilates and strength training. High-intensity activities and contact sports should be avoided.
If cervical insufficiency is diagnosed, your health care provider may ask you to cut down on a few activities and reduce the exertion.

But what if your doctor has advised no exercise?

If your health care provider has advised you to take bed rest/ or has asked you to cut down on activities, to maintain mobility, flexibility, and circulation, some easy and gentle exercises may help you. Exercises in a lying down position may include shoulder movements (taking shoulders up towards the head and again back, pressing both shoulders on the bed, bending elbows, and wrist rotations). Gentle pelvic tilts, Kegel’s exercises (pelvic floor contractions and relaxations), lower limb mobility may include knee bending, ankle pumps, and rotations. Each exercise can be repeated 8-10 times in one set. Exercises can be performed two times a day.

Breathing exercises can be beneficial during this phase. Gentle deep breathing (inhaling from the nose and exhaling through the mouth), keep both hands crossed over the lower part of the lungs, and try to inflate it by inhaling deeply from the nose. This exercise can be performed at different levels of the chest by focusing on one area at a time. Practicing breathing techniques during pregnancy helps in coping with the pain felt during labour.