link
Bookmarks
Cervical Insufficiency/Short Cervix
Anne M. Kennedy, MD
To access 4,300 diagnoses written by the world's leading experts in radiology, please log in or subscribe.Log inSubscribe
1
5
0
1

KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Clinical Issues

          • Diagnostic Checklist

            TERMINOLOGY

            • Synonyms

              • Cervical incompetence
            • Definitions

              • Cervical effacement: Process of softening, shortening, and thinning of cervix in preparation for delivery
              • Cervical dilation: Progress enlargement of cervical canal to fully dilated at 10 cm
              • Cervical insufficiency (CI): Inability of uterine cervix to retain pregnancy in 2nd-trimester, in absence of uterine contractions
                • Clinical diagnosis usually based on history of midtrimester loss without painful contractions
              • Short cervix: Cervical length (CL) < 10th percentile for gestational age (GA)
                • Sonographic observation: Length of < 25 mm at < 24 weeks
              • Funneling: Protrusion of amniotic membranes into cervical canal
                • Not shown to be independent risk factor for PTB
              • Preterm birth (PTB): Delivery before 37th week of pregnancy

            IMAGING

            • General Features

              • Ultrasonographic Findings

                • Imaging Recommendations

                  DIFFERENTIAL DIAGNOSIS

                    PATHOLOGY

                    • General Features

                      CLINICAL ISSUES

                      • Presentation

                        • Demographics

                          • Natural History & Prognosis

                            • Noninvasive Treatment

                              • Cerclage

                                DIAGNOSTIC CHECKLIST

                                • Consider

                                  • Reporting Tips

                                    Selected References

                                    1. Bruijn M et al: Quantitative fetal fibronectin testing in combination with cervical length measurement in the prediction of spontaneous preterm delivery in symptomatic women. BJOG. ePub, 2015
                                    2. Hezelgrave NL et al: Quantitative fetal fibronectin to predict spontaneous preterm birth: a review. Womens Health (Lond Engl). ePub, 2015
                                    3. Pandipati S et al: Prospective Evaluation of a Protocol for Using Transabdominal Ultrasound to Screen for Short Cervix. Am J Obstet Gynecol. ePub, 2015
                                    4. American College of Obstetricians and Gynecologists: ACOG Practice Bulletin No.142: Cerclage for the management of cervical insufficiency. Obstet Gynecol. 123(2 Pt 1):372-9, 2014
                                    5. Foster C et al: Fetal fibronectin as a biomarker of preterm labor: a review of the literature and advances in its clinical use. Biomark Med. 8(4):471-84, 2014
                                    6. Hatanaka AR et al: Amniotic fluid "sludge" is an independent risk factor for preterm delivery. J Matern Fetal Neonatal Med. 1-6, 2014
                                    7. Iams JD: Cervical length--time to report the rate of change? Am J Obstet Gynecol. 211(5):443, 2014
                                    8. Berghella V et al: Cervical assessment by ultrasound for preventing preterm delivery. Cochrane Database Syst Rev. 1:CD007235, 2013
                                    9. Deshpande SN et al: Rapid fetal fibronectin testing to predict preterm birth in women with symptoms of premature labour: a systematic review and cost analysis. Health Technol Assess. 17(40):1-138, 2013
                                    10. Romero R et al: A blueprint for the prevention of preterm birth: vaginal progesterone in women with a short cervix. J Perinat Med. 41(1):27-44, 2013
                                    11. Berghella V et al: Effectiveness of cerclage according to severity of cervical length shortening: a meta-analysis. Ultrasound Obstet Gynecol. 35(4):468-73, 2010
                                    12. Kalan AM et al: Mid-trimester cervical inflammatory milieu and sonographic cervical length. Am J Obstet Gynecol. 203(2):126, 2010
                                    13. Mancuso MS et al: Cervical funneling: effect on gestational length and ultrasound-indicated cerclage in high-risk women. Am J Obstet Gynecol. 203(3):259, 2010
                                    14. Debbs RH et al: Contemporary use of cerclage in pregnancy. Clin Obstet Gynecol. 52(4):597-610, 2009
                                    15. Berghella V et al: Cervical length assessment by ultrasound. Acta Obstet Gynecol Scand. 84(6):543-4, 2005
                                    16. Roman AS et al: The efficacy of sonographically indicated cerclage in multiple gestations. J Ultrasound Med. 24(6):763-8, 2005
                                    17. Rust OA et al: Does the presence of a funnel increase the risk of adverse perinatal outcome in a patient with a short cervix? Am J Obstet Gynecol. 192(4):1060-6, 2005
                                    18. To MS et al: Cervical cerclage for prevention of preterm delivery in women with short cervix: randomised controlled trial. Lancet. 363(9424):1849-53, 2004
                                    19. Berghella V et al: Does transvaginal sonographic measurement of cervical length before 14 weeks predict preterm delivery in high-risk pregnancies? Ultrasound Obstet Gynecol. 21(2):140-4, 2003
                                    20. Berghella V et al: Ultrasound assessment of the cervix. Clin Obstet Gynecol. 46(4):947-62, 2003
                                    21. Colombo DF et al: Cervical length and preterm labor. Clin Obstet Gynecol. 43(4):735-45, 2000
                                    22. Iams JD et al: The length of the cervix and the risk of spontaneous premature delivery. National Institute of Child Health and Human Development Maternal Fetal Medicine Unit Network. N Engl J Med. 334(9):567-72, 1996
                                    Related Anatomy
                                    Loading...
                                    Related Differential Diagnoses
                                    Loading...
                                    References
                                    Tables

                                    Tables

                                    KEY FACTS

                                    • Terminology

                                      • Imaging

                                        • Top Differential Diagnoses

                                          • Clinical Issues

                                            • Diagnostic Checklist

                                              TERMINOLOGY

                                              • Synonyms

                                                • Cervical incompetence
                                              • Definitions

                                                • Cervical effacement: Process of softening, shortening, and thinning of cervix in preparation for delivery
                                                • Cervical dilation: Progress enlargement of cervical canal to fully dilated at 10 cm
                                                • Cervical insufficiency (CI): Inability of uterine cervix to retain pregnancy in 2nd-trimester, in absence of uterine contractions
                                                  • Clinical diagnosis usually based on history of midtrimester loss without painful contractions
                                                • Short cervix: Cervical length (CL) < 10th percentile for gestational age (GA)
                                                  • Sonographic observation: Length of < 25 mm at < 24 weeks
                                                • Funneling: Protrusion of amniotic membranes into cervical canal
                                                  • Not shown to be independent risk factor for PTB
                                                • Preterm birth (PTB): Delivery before 37th week of pregnancy

                                              IMAGING

                                              • General Features

                                                • Ultrasonographic Findings

                                                  • Imaging Recommendations

                                                    DIFFERENTIAL DIAGNOSIS

                                                      PATHOLOGY

                                                      • General Features

                                                        CLINICAL ISSUES

                                                        • Presentation

                                                          • Demographics

                                                            • Natural History & Prognosis

                                                              • Noninvasive Treatment

                                                                • Cerclage

                                                                  DIAGNOSTIC CHECKLIST

                                                                  • Consider

                                                                    • Reporting Tips

                                                                      Selected References

                                                                      1. Bruijn M et al: Quantitative fetal fibronectin testing in combination with cervical length measurement in the prediction of spontaneous preterm delivery in symptomatic women. BJOG. ePub, 2015
                                                                      2. Hezelgrave NL et al: Quantitative fetal fibronectin to predict spontaneous preterm birth: a review. Womens Health (Lond Engl). ePub, 2015
                                                                      3. Pandipati S et al: Prospective Evaluation of a Protocol for Using Transabdominal Ultrasound to Screen for Short Cervix. Am J Obstet Gynecol. ePub, 2015
                                                                      4. American College of Obstetricians and Gynecologists: ACOG Practice Bulletin No.142: Cerclage for the management of cervical insufficiency. Obstet Gynecol. 123(2 Pt 1):372-9, 2014
                                                                      5. Foster C et al: Fetal fibronectin as a biomarker of preterm labor: a review of the literature and advances in its clinical use. Biomark Med. 8(4):471-84, 2014
                                                                      6. Hatanaka AR et al: Amniotic fluid "sludge" is an independent risk factor for preterm delivery. J Matern Fetal Neonatal Med. 1-6, 2014
                                                                      7. Iams JD: Cervical length--time to report the rate of change? Am J Obstet Gynecol. 211(5):443, 2014
                                                                      8. Berghella V et al: Cervical assessment by ultrasound for preventing preterm delivery. Cochrane Database Syst Rev. 1:CD007235, 2013
                                                                      9. Deshpande SN et al: Rapid fetal fibronectin testing to predict preterm birth in women with symptoms of premature labour: a systematic review and cost analysis. Health Technol Assess. 17(40):1-138, 2013
                                                                      10. Romero R et al: A blueprint for the prevention of preterm birth: vaginal progesterone in women with a short cervix. J Perinat Med. 41(1):27-44, 2013
                                                                      11. Berghella V et al: Effectiveness of cerclage according to severity of cervical length shortening: a meta-analysis. Ultrasound Obstet Gynecol. 35(4):468-73, 2010
                                                                      12. Kalan AM et al: Mid-trimester cervical inflammatory milieu and sonographic cervical length. Am J Obstet Gynecol. 203(2):126, 2010
                                                                      13. Mancuso MS et al: Cervical funneling: effect on gestational length and ultrasound-indicated cerclage in high-risk women. Am J Obstet Gynecol. 203(3):259, 2010
                                                                      14. Debbs RH et al: Contemporary use of cerclage in pregnancy. Clin Obstet Gynecol. 52(4):597-610, 2009
                                                                      15. Berghella V et al: Cervical length assessment by ultrasound. Acta Obstet Gynecol Scand. 84(6):543-4, 2005
                                                                      16. Roman AS et al: The efficacy of sonographically indicated cerclage in multiple gestations. J Ultrasound Med. 24(6):763-8, 2005
                                                                      17. Rust OA et al: Does the presence of a funnel increase the risk of adverse perinatal outcome in a patient with a short cervix? Am J Obstet Gynecol. 192(4):1060-6, 2005
                                                                      18. To MS et al: Cervical cerclage for prevention of preterm delivery in women with short cervix: randomised controlled trial. Lancet. 363(9424):1849-53, 2004
                                                                      19. Berghella V et al: Does transvaginal sonographic measurement of cervical length before 14 weeks predict preterm delivery in high-risk pregnancies? Ultrasound Obstet Gynecol. 21(2):140-4, 2003
                                                                      20. Berghella V et al: Ultrasound assessment of the cervix. Clin Obstet Gynecol. 46(4):947-62, 2003
                                                                      21. Colombo DF et al: Cervical length and preterm labor. Clin Obstet Gynecol. 43(4):735-45, 2000
                                                                      22. Iams JD et al: The length of the cervix and the risk of spontaneous premature delivery. National Institute of Child Health and Human Development Maternal Fetal Medicine Unit Network. N Engl J Med. 334(9):567-72, 1996