Cervical Insufficiency
Definition
Premature cervical shortening and pregnancy loss/ prem in 2nd trimester
Aetiology
Risk Factors
Cervical - congenital
Cervical - acquired
Pathogenesis
Clinical Features
Symptoms (~ 14-20/40)
Signs
Initial
Late
Investigations
Management
Source
UpToDate 2013
Premature cervical shortening and pregnancy loss/ prem in 2nd trimester
Aetiology
- Structural weakness
- Decidual inflammation/ infection
- Haemorrhage
- Uterine overdistension
Risk Factors
- Past hx
Cervical - congenital
- Collagen abnormalities
- Uterine abnormalities
- DES exposure
- Biologic variation
Cervical - acquired
- Previous obstetric trauma
- Hx Mechanical dilation (D+C)
- Rx of CIN
Pathogenesis
- Biochemical changes by non-structural causes in cervix --> premature shortening
Clinical Features
Symptoms (~ 14-20/40)
- Asymptomatic, or
- Spotting
- Pelvic pressure
- PMS like cramping/ backache
- ++ vaginal d/c (change in colour from white to pink/tan, thinner)
- No/ mild contractions
Signs
Initial
- Soft effaced cervix
- Minimal dilation
- CTG no contractions/ irregular mid contraction
Late
- Dilation and effacement with unsync + irregular contractions
- Spotting
- Prolapsed membrane
Investigations
- Imaging: TVUS (<28/40, <25mm cervical length = ++ risk of prem/ ++ debris in amniotic fluid)
Management
- Cerclage @ 12-14/40 if PHx
- Pessary (displace wt away from cervix)
Source
UpToDate 2013