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
Romero R: Spontaneous preterm labor can be predicted and prevented. Ultrasound Obstet Gynecol. 57(1):19-21, 2021
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
Clark NV et al: Laparoscopic abdominal cerclage: a highly effective option for refractory cervical insufficiency. Fertil Steril. 113(4):717-22, 2020
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
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
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
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
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
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
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
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
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
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
Hezelgrave NL et al: Quantitative fetal fibronectin to predict spontaneous preterm birth: a review. Womens Health (Lond Engl).12(1):121-8, 2015
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
Romero R: Spontaneous preterm labor can be predicted and prevented. Ultrasound Obstet Gynecol. 57(1):19-21, 2021
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
Clark NV et al: Laparoscopic abdominal cerclage: a highly effective option for refractory cervical insufficiency. Fertil Steril. 113(4):717-22, 2020
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
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
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
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
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
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
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
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
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
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
Hezelgrave NL et al: Quantitative fetal fibronectin to predict spontaneous preterm birth: a review. Womens Health (Lond Engl).12(1):121-8, 2015
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
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