Case 12 - A 25-Year-Old with Cervical Insufficiency at 18 Weeks

Summary

Cervical insufficiency is defined as the inability of the uterine cervix to retain a pregnancy, resulting in the subsequent delivery of the pregnancy in the absence of signs and symptoms consistent with labor, placental abruption, or both during the second trimester. It can be diagnosed based on obstetrical history, where painless cervical dilation in the second trimester led to pregnancy loss, or through physical examination findings in a current singleton pregnancy, revealing advanced painless cervical dilation. Treatment methods primarily rely on cervical cerclage placement using either transvaginal or transabdominal approaches. A cerclage may also be indicated to reduce the risk of preterm birth in a current singleton gestation with a shortened cervical length of under 25 mm, especially in the context of a history of preterm delivery before 34 weeks of gestation. The use of vaginal progesterone alone for the treatment of cervical insufficiency has not demonstrated effectiveness, although it might be beneficial in patients with singleton pregnancies and an incidentally found shortened cervical length.