Cervical insufficiency and cervical cerclage




Cervical insufficiency (also known as cervical incompetence)



Definition


Refers to an inability to support a pregnancy to term due to a functional defect of the cervix.



Incidence


This is 0.05–1% of all pregnancies.



Clinical features



  • Cervical insufficiency is characterized by acute, painless dilation of the cervix, usually in the mid-trimester, culminating in prolapse and/or preterm premature rupture of the membranes (PPROM) with resultant preterm and often pre-viable delivery.
  • Symptoms may include watery vaginal discharge, pelvic pressure, vaginal bleeding, and/or PPROM in the mid-trimester, but most women are asymptomatic.


Diagnosis



  • Cervical insufficiency is a clinical diagnosis. It should be suspected when an advanced cervical dilation examination is noted at 16–24 weeks’ gestation on pelvic (or sonographic) examination in the absence of uterine contractions. If uterine contractions are present, the diagnosis is more likely to be preterm labor.
  • Several tests have been described in an attempt to confirm the diagnosis in non-pregnant women, but are of little clinical value.


Etiology


Cervical insufficiency is likely to be the clinical end-point of many pathologic processes. In most cases, the precise etiology is unknown.



Future pregnancies



  • The probability of cervical insufficiency recurring in a subsequent pregnancy is 15–30%.
  • The chance of carrying a pregnancy to term with a history of two consecutive mid-trimester pregnancy losses is 60–70%.

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Jun 6, 2016 | Posted by in GYNECOLOGY | Comments Off on Cervical insufficiency and cervical cerclage

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