Hi friends today we are going to talk about cervical infufficiency briefly.
Cervical insufficiency (or cervical incompetency) :
Its defined inability of the uterine cervix to retain a pregnancy to viability in the absence of contractions or labor.
Causes of cervical insufficiency:
1- trauma from rapid forceful cervical dilation associated with second trimester abortion procedures.
2-cervical laceration from rapid delivery.
3-injury from deep cervical conization(cone biopsy).
4-congenital weakness from diethylstilbestrol (DES) exposure(which is synthetic eastrogen has been used in the past its believed that the mother of the women during her pregnancy if used DES her daughter may develope many problems from which is cervical weakness.
- In the past, a diagnosis was made on the basis of a history of painless cervical dilation after the first trimester with expulsion of a previable living fetus.
obestetric triad of cervical insufficiency:
1-Pregnant 18–22 weeks
2-Painless cervical dilation
3-Delivery of previable fetus
1-sonographic findings of a short cervix or funneling.
2-history of cervical surgery or DES exposure.
- With sonographic demonstration for fetal normality, elective cerclage placement at 13–14 weeks’ gestation. With sonographic evidence of cervical insufficiency after ruling out labor and chorioamnionitis, possible emergency or urgent cerclage.
- Consider cerclage if cervical length <25 mm by vaginal sonography prior to 24 weeks and prior preterm birth at <34 weeks gestation.
- McDonald cerclage places a removable suture in the cervix. The benefit is that vaginal delivery can be allowed to take place, avoiding a cesarean.
- Shirodkar cerclage utilizes a submucosal placement of the suture that is buried beneath the mucosa and left in place. Cesarean delivery is performed at term.
- Cerclage removal should take place at 36–37 weeks, after fetal lung maturity has taken place but before the usual onset of spontaneous labor that could result in avulsion of the suture.