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Cervical Insufficiency/Short Cervix
Anne Kennedy, MD
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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: Progressive enlargement of cervix 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)
              • 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

                        • Natural History & Prognosis

                          • Noninvasive Treatment

                            • Cerclage

                              DIAGNOSTIC CHECKLIST

                              • Consider

                                • Reporting Tips

                                  Selected References

                                  1. Romero R: Spontaneous preterm labor can be predicted and prevented. Ultrasound Obstet Gynecol. 57(1):19-21, 2021
                                  2. Chen CY et al: Assessment of the cervix in pregnant women with a history of cervical insufficiency during the first trimester using elastography. Acta Obstet Gynecol Scand. 99(11):1497-503, 2020
                                  3. Clark NV et al: Laparoscopic abdominal cerclage: a highly effective option for refractory cervical insufficiency. Fertil Steril. 113(4):717-22, 2020
                                  4. Conde-Agudelo A et al: Cervical pessary to prevent preterm birth in asymptomatic high-risk women: a systematic review and meta-analysis. Am J Obstet Gynecol. 223(1):42-65.e2, 2020
                                  5. Debiève F et al: Transabdominal cerclage for cervical insufficiency in twins: series of seven cases and literature review. J Matern Fetal Neonatal Med. 33(21):3579-83, 2020
                                  6. Expert Panel on Gyn and OB Imaging. et al: ACR Appropriateness Criteria® Assessment of Gravid Cervix. J Am Coll Radiol. 17(5S):S26-35, 2020
                                  7. Roman A et al: Physical examination-indicated cerclage in twin pregnancy: a randomized controlled trial. Am J Obstet Gynecol. 223(6):902.e1-11, 2020
                                  8. Society for Maternal-Fetal Medicine (SMFM). Electronic address: [email protected] et al: Society for Maternal-Fetal Medicine Consult Series #50: The role of activity restriction in obstetric management: (Replaces Consult Number 33, August 2014). Am J Obstet Gynecol. 223(2):B2-10, 2020
                                  9. Jarde A et al: Vaginal progesterone, oral progesterone, 17-OHPC, cerclage, and pessary for preventing preterm birth in at-risk singleton pregnancies: an updated systematic review and network meta-analysis. BJOG. 126(5):556-7, 2019
                                  10. Merced C et al: Cervical pessary for preventing preterm birth in twin pregnancies with maternal short cervix after an episode of threatened preterm labor: randomised controlled trial. Am J Obstet Gynecol. 221(1):55.e1-55.e14, 2019
                                  11. Mönckeberg M et al: Patients with acute cervical insufficiency without intra-amniotic infection/inflammation treated with cerclage have a good prognosis. J Perinat Med. 47(5):500-9, 2019
                                  12. Conde-Agudelo A et al: Vaginal progesterone is as effective as cervical cerclage to prevent preterm birth in women with a singleton gestation, previous spontaneous preterm birth, and a short cervix: updated indirect comparison meta-analysis. Am J Obstet Gynecol. 219(1):10-25, 2018
                                  13. 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. 123(12):1965-71, 2015
                                  14. Hezelgrave NL et al: Quantitative fetal fibronectin to predict spontaneous preterm birth: a review. Womens Health (Lond Engl).12(1):121-8, 2015
                                  15. 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
                                  Related Anatomy
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                                  Related Differential Diagnoses
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                                  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: Progressive enlargement of cervix 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)
                                              • 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

                                                        • Natural History & Prognosis

                                                          • Noninvasive Treatment

                                                            • Cerclage

                                                              DIAGNOSTIC CHECKLIST

                                                              • Consider

                                                                • Reporting Tips

                                                                  Selected References

                                                                  1. Romero R: Spontaneous preterm labor can be predicted and prevented. Ultrasound Obstet Gynecol. 57(1):19-21, 2021
                                                                  2. Chen CY et al: Assessment of the cervix in pregnant women with a history of cervical insufficiency during the first trimester using elastography. Acta Obstet Gynecol Scand. 99(11):1497-503, 2020
                                                                  3. Clark NV et al: Laparoscopic abdominal cerclage: a highly effective option for refractory cervical insufficiency. Fertil Steril. 113(4):717-22, 2020
                                                                  4. Conde-Agudelo A et al: Cervical pessary to prevent preterm birth in asymptomatic high-risk women: a systematic review and meta-analysis. Am J Obstet Gynecol. 223(1):42-65.e2, 2020
                                                                  5. Debiève F et al: Transabdominal cerclage for cervical insufficiency in twins: series of seven cases and literature review. J Matern Fetal Neonatal Med. 33(21):3579-83, 2020
                                                                  6. Expert Panel on Gyn and OB Imaging. et al: ACR Appropriateness Criteria® Assessment of Gravid Cervix. J Am Coll Radiol. 17(5S):S26-35, 2020
                                                                  7. Roman A et al: Physical examination-indicated cerclage in twin pregnancy: a randomized controlled trial. Am J Obstet Gynecol. 223(6):902.e1-11, 2020
                                                                  8. Society for Maternal-Fetal Medicine (SMFM). Electronic address: [email protected] et al: Society for Maternal-Fetal Medicine Consult Series #50: The role of activity restriction in obstetric management: (Replaces Consult Number 33, August 2014). Am J Obstet Gynecol. 223(2):B2-10, 2020
                                                                  9. Jarde A et al: Vaginal progesterone, oral progesterone, 17-OHPC, cerclage, and pessary for preventing preterm birth in at-risk singleton pregnancies: an updated systematic review and network meta-analysis. BJOG. 126(5):556-7, 2019
                                                                  10. Merced C et al: Cervical pessary for preventing preterm birth in twin pregnancies with maternal short cervix after an episode of threatened preterm labor: randomised controlled trial. Am J Obstet Gynecol. 221(1):55.e1-55.e14, 2019
                                                                  11. Mönckeberg M et al: Patients with acute cervical insufficiency without intra-amniotic infection/inflammation treated with cerclage have a good prognosis. J Perinat Med. 47(5):500-9, 2019
                                                                  12. Conde-Agudelo A et al: Vaginal progesterone is as effective as cervical cerclage to prevent preterm birth in women with a singleton gestation, previous spontaneous preterm birth, and a short cervix: updated indirect comparison meta-analysis. Am J Obstet Gynecol. 219(1):10-25, 2018
                                                                  13. 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. 123(12):1965-71, 2015
                                                                  14. Hezelgrave NL et al: Quantitative fetal fibronectin to predict spontaneous preterm birth: a review. Womens Health (Lond Engl).12(1):121-8, 2015
                                                                  15. 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