1. INCOMPETENT CERVIX Definition: painless dilatation of the cervix without contractions

2. RISK FACTORS  CONGENITAL INCOMPETENCE  ACQUIRED INCOMPETENCE

3. CONGENITAL INCOMPETENCE Women exposed to DES Women with a bicornuate uterus

4. ACQUIRED CERVICAL INCOMPETENCE Inflammation Infection Subclinical uterine activity Cervical trauma Increased uterine volume

5. IDENTIFICATION OF WOMEN WITH INCOMPETENT CERVIX Obstetrical history: repetitive second trimester losses, previous preterm birth, previous elective abortions or cervical manipulation

7. MANAGEMENT CONSERVATIVE MANAGEMENT: bed rest; avoidance of heavy lifting; no coitus WOMEN WITH PREVIOUS LOSSES: elective cervical cerclage (late first trimester or early second trimester)

9. CARE OF THE WOMAN FOLLOWING AN ELECTIVE CERCLAGE Assessment of vaginal bleeding Assessment of uterine activity Assessment of vital signs Assessment of urine output Ultrasound