Study Links Cervical Insufficiency to Pelvic Floor Disorders

Results provide first step toward treatments to help with tissue strength

Innovations in Obstetrics & Gynecology - Fall 2018

David Sheyn, MD David Sheyn, MD
Sherif El-Nashar, MD, PhD Sherif El-Nashar, MD, PhD

Many women who have cervical insufficiency – defined as painless cervical dilation that can lead to preterm delivery– can later go on to have pelvic organ prolapse and urinary incontinence surgery, according to observations by a team of physicians in the Department of Obstetrics and Gynecology at University Hospitals Cleveland Medical Center. The team hypothesized that there was an inherent connective tissue quality issue linking cervical insufficiency to the risk of pelvic organ prolapse and urinary incontinence.

“No one had linked the two yet,” says lead study author David Sheyn, MD, a Fellow in the Division of Female Pelvic Medicine and Reconstructive Surgery at UH Cleveland Medical Center and Clinical Instructor, Case Western Reserve University School of Medicine.  “We wanted to see if there was an increased risk [for pelvic organ prolapse and urinary incontinence] in people who have cervical insufficiency and preterm birth compared to women who had the same number of vaginal deliveries. From there, we could investigate the basis with targeted molecular studies.”


The large retrospective, observational study1 was conducted using de-identified patient data from the IBM Explorys platform, which combines a wide variety of databases from across multiple different clinical and payer sources. The platform has databases from 26 large hospital systems, representing more than 40 million patients, according to Dr. Sheyn.

“There are a lot of hospital systems in the country,” he says. “UH is one of only 26 systems participating in this IBM program. UH is a part of the ‘big data’ revolution.”

The database was used to find patients who had surgery while they were pregnant to help with cervical insufficiency, explains Sherif El-Nashar, MD, PhD, Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, UH Cleveland Medical Center and Associate Professor, Case Western Reserve University School of Medicine. “We then followed those patients in the database to see if they later underwent surgery to treat pelvic organ prolapse or urinary incontinence.”

The physicians involved in the study found that cervical insufficiency is a significant risk factor for later pelvic organ prolapse and urinary incontinence. “Even patients who had cervical insufficiency and no births to term had a higher risk than women with the same number of vaginal deliveries,” Dr. Sheyn says. “The molecular-based tissue changes in the cervix and pelvic support are actually more important than the tissue damage that occurs with vaginal delivery.”


Though there is no immediate solution for cervical insufficiency and accompanying risk of pelvic organ prolapse and urinary incontinence, it is an important first step discovery. “It seems there is a specific pattern of disease that all depends on connective tissue quality,” Dr. El-Nashar says. “It makes us think that maybe in the future we could have a medical treatment that would help with tissue strength, hopefully preventing the loss of babies and negating the need for surgery in those patients.”

Dr. Sheyn sees similar possibilities in the future. “If we were to identify similar molecular processes, we could possibly discover targeted medications and treatments to prevent cervical insufficiency, preterm births and pelvic floor disorders,” he says.

In the interim, it could be possible to identify patients with cervical insufficiency, and patients who are at high risk for pelvic organ prolapse and urinary incontinence. Once identified, these women could undergo physical therapy to strengthen their pelvic floor muscles as a preventative measure.

The study has opened the door to further research. “Our academic department is working in different directions to do research and help women across the entire spectrum,” Dr. El-Nashar says.


Individualized Multiple Variable Regression Model Table 
1Sheyn D, Addae-Konaedu KL, Bauer AM, Dawodu KI, Hackney DN, El-Nashar SA. History of cervical insufficiency increases the risk of pelvic organ prolapse and stress urinary incontinence in parous women. Maturitas. 2018 Jan;107:63-67.

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