Cervical insufficiency is defined as inability of uterine cervix to hold pregnancy in second trimester without contractions.
Acute painless dilatation of cervix leads to mid-trimester pregnancy loss. Absence of contractions or labor makes detection challenging until complications.
During a typical pregnancy the cervix remains firm and closed until late in the third trimester.
Cervical collagen abnormalities cause premature dilation. Biochemical deficiencies may weaken and shorten the cervix during early pregnancy.
Cervical dilation may occur without pain or contractions to cause premature birth or miscarriage.
Cervical insufficiency weakens or opens cervix before expected during pregnancy.
Diagnosis of cervical insufficiency involves history of previous mid-trimester loss with painless cervical dilatation in the second trimester.
Epidemiology
Cervical insufficiency affects 0.5 to 1% of pregnancy cases to cause 8 to 15% of second trimester losses are linked to 15 to 20% of recurrent losses.
Short cervix as surrogate marker for risk in 1-2% of mid-trimester pregnancies. Increased risk of preterm labor or second-trimester loss for women with history of same complications.
Limited resources can result in more undiagnosed cases and pregnancy complications. Black women might have higher rates of preterm labor and cervical insufficiency for unknown reasons.
Women with prior cervical insufficiency pregnancy has 14 to 30% recurrence risk in future.
Anatomy
Pathophysiology
Cervix forms through fusion and recanalization of paramesonephric ducts due to 20 weeks gestation.
The cervix is made of muscle and fibrous tissue with fibrous tissue provide strength.
Structural weakness at junction may cause cervical insufficiency to premature shortening and preterm delivery risks.
The cervix needs a balance of smooth muscle, collagen, and elastin for structural integrity. Imbalance in cervical insufficiency causes a soft, weak cervix prone to early dilation from pressure.
Hormonal changes can cause cervix to soften and dilate early. Progesterone maintains cervix rigidity to prevent premature opening.
Etiology
The cause of cervical insufficiency is:
Congenital Factors
Trauma-Related and Iatrogenic Factors
Hormonal and Biochemical Factors
Infections or Inflammatory Causes
Structural Abnormalities
Genetics
Prognostic Factors
Previous painless second-trimester loss or preterm birth suggests poor prognosis.
More preterm deliveries or second-trimester losses lead to cervical insufficiency.
Cervical length ≤ 25 mm at 16-24 weeks increases preterm birth risk and poor outcomes.
Prophylactic cerclage before cervical changes improves outcomes for women with insufficiency.
Clinical History
Collect details including symptom history in current pregnancy, gynaecological, and medical and genetic history to understand clinical history of patient.
Physical Examination
Bimanual pelvic examination
Speculum examination
General assessment
Age group
Associated comorbidity
Associated activity
Acuity of presentation
Asymptomatic symptoms are:
Detection during Routine Ultrasound
Gradual Cervical Shortening
Acute symptoms are:
Advanced Cervical Dilation without Pain
Bulging Membranes
Differential Diagnoses
Abruptio Placentae
Fetal Growth Restriction
Multifetal Pregnancy
Premature Rupture of Membranes
Laboratory Studies
Imaging Studies
Procedures
Histologic Findings
Staging
Treatment Paradigm
Cervical cerclage is a common surgical treatment for cervical insufficiency to improve cervix tensile strength.
Cerclage placement not recommended for women with multiple gestations and short cervix due to risks.
Clinical evaluation required for bleeding, preterm labor, and PPROM as contraindications to cerclage placement in women with cervical evidence.
Vaginal progesterone helps women with short cervix who have not had preterm births reduce early delivery.
Cervical pessary studied for 50 years as non-invasive treatment for cervical insufficiency.
Limited evidence on pessaries for cervical insufficiency treatment effectiveness.
Cervical cerclage is effective for recurrent pregnancy loss or advanced dilation while pessaries is indicated to shortened cervix.
use-of-phases-in-managing-cervical-insufficiency
The initial treatment phase includes risk assessment, counseling, and optimization of health.
Pharmacologic therapy is effective in the treatment phase as it includes use of tocolytic agents, corticosteroids, and progesterone therapy.
In supportive care and management phase, patients should receive required attention such as lifestyle modification and surgical intervention therapies.
The regular follow-up visits with the gynecologist are scheduled to check the improvement of patients along with treatment response.
Cervical insufficiency is defined as inability of uterine cervix to hold pregnancy in second trimester without contractions.
Acute painless dilatation of cervix leads to mid-trimester pregnancy loss. Absence of contractions or labor makes detection challenging until complications.
During a typical pregnancy the cervix remains firm and closed until late in the third trimester.
Cervical collagen abnormalities cause premature dilation. Biochemical deficiencies may weaken and shorten the cervix during early pregnancy.
Cervical dilation may occur without pain or contractions to cause premature birth or miscarriage.
Cervical insufficiency weakens or opens cervix before expected during pregnancy.
Diagnosis of cervical insufficiency involves history of previous mid-trimester loss with painless cervical dilatation in the second trimester.
Cervical insufficiency affects 0.5 to 1% of pregnancy cases to cause 8 to 15% of second trimester losses are linked to 15 to 20% of recurrent losses.
Short cervix as surrogate marker for risk in 1-2% of mid-trimester pregnancies. Increased risk of preterm labor or second-trimester loss for women with history of same complications.
Limited resources can result in more undiagnosed cases and pregnancy complications. Black women might have higher rates of preterm labor and cervical insufficiency for unknown reasons.
Women with prior cervical insufficiency pregnancy has 14 to 30% recurrence risk in future.
Cervix forms through fusion and recanalization of paramesonephric ducts due to 20 weeks gestation.
The cervix is made of muscle and fibrous tissue with fibrous tissue provide strength.
Structural weakness at junction may cause cervical insufficiency to premature shortening and preterm delivery risks.
The cervix needs a balance of smooth muscle, collagen, and elastin for structural integrity. Imbalance in cervical insufficiency causes a soft, weak cervix prone to early dilation from pressure.
Hormonal changes can cause cervix to soften and dilate early. Progesterone maintains cervix rigidity to prevent premature opening.
The cause of cervical insufficiency is:
Congenital Factors
Trauma-Related and Iatrogenic Factors
Hormonal and Biochemical Factors
Infections or Inflammatory Causes
Structural Abnormalities
Previous painless second-trimester loss or preterm birth suggests poor prognosis.
More preterm deliveries or second-trimester losses lead to cervical insufficiency.
Cervical length ≤ 25 mm at 16-24 weeks increases preterm birth risk and poor outcomes.
Prophylactic cerclage before cervical changes improves outcomes for women with insufficiency.
Collect details including symptom history in current pregnancy, gynaecological, and medical and genetic history to understand clinical history of patient.
Bimanual pelvic examination
Speculum examination
General assessment
Asymptomatic symptoms are:
Detection during Routine Ultrasound
Gradual Cervical Shortening
Acute symptoms are:
Advanced Cervical Dilation without Pain
Bulging Membranes
Abruptio Placentae
Fetal Growth Restriction
Multifetal Pregnancy
Premature Rupture of Membranes
Cervical cerclage is a common surgical treatment for cervical insufficiency to improve cervix tensile strength.
Cerclage placement not recommended for women with multiple gestations and short cervix due to risks.
Clinical evaluation required for bleeding, preterm labor, and PPROM as contraindications to cerclage placement in women with cervical evidence.
Vaginal progesterone helps women with short cervix who have not had preterm births reduce early delivery.
Cervical pessary studied for 50 years as non-invasive treatment for cervical insufficiency.
Limited evidence on pessaries for cervical insufficiency treatment effectiveness.
OB/GYN and Women\'s Health
Reduce physical activity to relieve pressure on the cervix in women.
Complete bed rest is also not recommended due to potential risks.
Women are advised to avoid heavy lifting and prolonged standing to reduce intra-abdominal pressure.
Patient should be positioned on the left side to improve uteroplacental blood flow on the cervix.
Maintain a comfortable room temperature to avoid dehydration and uterine irritability.
Proper awareness about cervical insufficiency should be provided and its related causes with management strategies.
Appointments with a gynaecologist and preventing recurrence of disorder is an ongoing life-long effort.
OB/GYN and Women\'s Health
Nifedipine:
It inhibits transmembrane influx of extracellular calcium ions across myocardial and vascular smooth muscle cell membranes.
OB/GYN and Women\'s Health
Dexamethasone:
It suppresses migration of polymorphonuclear leukocytes to stabilize cells and lysosomal membranes.
OB/GYN and Women\'s Health
Progesterone:
It is indicated for women in cervical insufficiency or shortened cervix cases.
OB/GYN and Women\'s Health
Cervical cerclage is effective for recurrent pregnancy loss or advanced dilation while pessaries is indicated to shortened cervix.
OB/GYN and Women\'s Health
The initial treatment phase includes risk assessment, counseling, and optimization of health.
Pharmacologic therapy is effective in the treatment phase as it includes use of tocolytic agents, corticosteroids, and progesterone therapy.
In supportive care and management phase, patients should receive required attention such as lifestyle modification and surgical intervention therapies.
The regular follow-up visits with the gynecologist are scheduled to check the improvement of patients along with treatment response.
Cervical insufficiency is defined as inability of uterine cervix to hold pregnancy in second trimester without contractions.
Acute painless dilatation of cervix leads to mid-trimester pregnancy loss. Absence of contractions or labor makes detection challenging until complications.
During a typical pregnancy the cervix remains firm and closed until late in the third trimester.
Cervical collagen abnormalities cause premature dilation. Biochemical deficiencies may weaken and shorten the cervix during early pregnancy.
Cervical dilation may occur without pain or contractions to cause premature birth or miscarriage.
Cervical insufficiency weakens or opens cervix before expected during pregnancy.
Diagnosis of cervical insufficiency involves history of previous mid-trimester loss with painless cervical dilatation in the second trimester.
Cervical insufficiency affects 0.5 to 1% of pregnancy cases to cause 8 to 15% of second trimester losses are linked to 15 to 20% of recurrent losses.
Short cervix as surrogate marker for risk in 1-2% of mid-trimester pregnancies. Increased risk of preterm labor or second-trimester loss for women with history of same complications.
Limited resources can result in more undiagnosed cases and pregnancy complications. Black women might have higher rates of preterm labor and cervical insufficiency for unknown reasons.
Women with prior cervical insufficiency pregnancy has 14 to 30% recurrence risk in future.
Cervix forms through fusion and recanalization of paramesonephric ducts due to 20 weeks gestation.
The cervix is made of muscle and fibrous tissue with fibrous tissue provide strength.
Structural weakness at junction may cause cervical insufficiency to premature shortening and preterm delivery risks.
The cervix needs a balance of smooth muscle, collagen, and elastin for structural integrity. Imbalance in cervical insufficiency causes a soft, weak cervix prone to early dilation from pressure.
Hormonal changes can cause cervix to soften and dilate early. Progesterone maintains cervix rigidity to prevent premature opening.
The cause of cervical insufficiency is:
Congenital Factors
Trauma-Related and Iatrogenic Factors
Hormonal and Biochemical Factors
Infections or Inflammatory Causes
Structural Abnormalities
Previous painless second-trimester loss or preterm birth suggests poor prognosis.
More preterm deliveries or second-trimester losses lead to cervical insufficiency.
Cervical length ≤ 25 mm at 16-24 weeks increases preterm birth risk and poor outcomes.
Prophylactic cerclage before cervical changes improves outcomes for women with insufficiency.
Collect details including symptom history in current pregnancy, gynaecological, and medical and genetic history to understand clinical history of patient.
Bimanual pelvic examination
Speculum examination
General assessment
Asymptomatic symptoms are:
Detection during Routine Ultrasound
Gradual Cervical Shortening
Acute symptoms are:
Advanced Cervical Dilation without Pain
Bulging Membranes
Abruptio Placentae
Fetal Growth Restriction
Multifetal Pregnancy
Premature Rupture of Membranes
Cervical cerclage is a common surgical treatment for cervical insufficiency to improve cervix tensile strength.
Cerclage placement not recommended for women with multiple gestations and short cervix due to risks.
Clinical evaluation required for bleeding, preterm labor, and PPROM as contraindications to cerclage placement in women with cervical evidence.
Vaginal progesterone helps women with short cervix who have not had preterm births reduce early delivery.
Cervical pessary studied for 50 years as non-invasive treatment for cervical insufficiency.
Limited evidence on pessaries for cervical insufficiency treatment effectiveness.
OB/GYN and Women\'s Health
Reduce physical activity to relieve pressure on the cervix in women.
Complete bed rest is also not recommended due to potential risks.
Women are advised to avoid heavy lifting and prolonged standing to reduce intra-abdominal pressure.
Patient should be positioned on the left side to improve uteroplacental blood flow on the cervix.
Maintain a comfortable room temperature to avoid dehydration and uterine irritability.
Proper awareness about cervical insufficiency should be provided and its related causes with management strategies.
Appointments with a gynaecologist and preventing recurrence of disorder is an ongoing life-long effort.
OB/GYN and Women\'s Health
Nifedipine:
It inhibits transmembrane influx of extracellular calcium ions across myocardial and vascular smooth muscle cell membranes.
OB/GYN and Women\'s Health
Dexamethasone:
It suppresses migration of polymorphonuclear leukocytes to stabilize cells and lysosomal membranes.
OB/GYN and Women\'s Health
Progesterone:
It is indicated for women in cervical insufficiency or shortened cervix cases.
OB/GYN and Women\'s Health
Cervical cerclage is effective for recurrent pregnancy loss or advanced dilation while pessaries is indicated to shortened cervix.
OB/GYN and Women\'s Health
The initial treatment phase includes risk assessment, counseling, and optimization of health.
Pharmacologic therapy is effective in the treatment phase as it includes use of tocolytic agents, corticosteroids, and progesterone therapy.
In supportive care and management phase, patients should receive required attention such as lifestyle modification and surgical intervention therapies.
The regular follow-up visits with the gynecologist are scheduled to check the improvement of patients along with treatment response.
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