1. Cervical Incompetence
Harim

2. Reference Lecture notes from Ewha OBGY professors
Obstetrics: Normal and Problem Pregnancies, Chapter 28, e1
Ferri’s clinical advisor, 2018
Creasy and Resnik's Maternal-Fetal Medicine: Principles and Practice, 41, e2

3. Definition Competent/sufficient cervix?
- keeping the fetus and membranes inside the uterus until the end of gestation
Imcompetent cervix?
Incapable of this
In the second or third trimester, cervix gets dilatated WITHOUT labor
Short cervix by sonographic imaging
Typical cervical insufficiency history

4. Normal Cervix in Pregnancy
By 30w, stable cervix  gets shorter afterwards.
14-22 w : mm
24-28 w : 35mm
Term: 30 mm

5. Risk factors
Inborn factors: uterine anomaly, intrauterine exposure of DES (fetus), collagen abnormalities
Acquired factors: Prior cervical surgery (conization, loop electrosurgical excision procedure), DES(diethylstilbestrol) exposure, prior spontaneous preterm births, multiple gestations, prior cervical trauma

6. Clinical Manifestation
NO typical symptom
Pelvic pain, backache, vaginal spotting, vaginal pressure (?)

7. Diagnosis 4 clinical signs
Recurrent pregnancy loss after 2nd trimester
Cervical dilatation after 2nd trimester WITHOUT uterine contraction
Gradually shortening cervix with typical history of cervical insufficiency
Funneling shape on sonographic imaging
Short cervix (<2.5cm) , funneling shape!

8. Sonographic findings

9. Treatment Cerclage - transvaginal: McDonald , Shirodkar
- transabdominal approach (10-14w)
Prophylactic cerclage : 10-16w
16-24w, if cervix is < mm, funneling (therapeutic)
Anytime after 1st trimester (emergency), prolapsed membrane
The cerclage may be removed at 37w
Creasy and Resnik's Maternal-Fetal Medicine: Principles and Practice.
Berghella, Vincenzo, MD; Iams, Jay D., MD. Published January 1, Pages e2. © 2014.

10. Treatment Non-surgical treatment options Progesterone Bed rest BB
Antibiotics
Anti-inflammatory (?)

11. Contraindications to Cerclage
• Severe fetal anomaly
• Intrauterine infection
• Active bleeding
• Active labor
• Preterm ruptured membranes
• Fetal death

12. Thank you!