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Chapter 8 - Cervical Insufficiency

from Section 1 - Obstetric Aspects of Antenatal Care

Published online by Cambridge University Press:  23 February 2023

By
Marie-Julie Trahan ,
Amira El-Messidi  and
Richard Brown
Edited by
Amira El-Messidi  and
Alan D. Cameron
Amira El-Messidi
Affiliation:
McGill University, Montréal
Alan D. Cameron
Affiliation:
University of Glasgow
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Summary

A 30-year-old G6P2A4L1 is referred by her primary care provider to your high-risk obstetrics clinic for preconception counseling after a pregnancy loss at 21+4 weeks’ gestation last year, shortly after incidental transvaginal cervical shortening was noted at second-trimester fetal morphology survey. After an uncomplicated first pregnancy and term delivery, she experienced four consecutive first-trimester losses for which comprehensive investigations were unremarkable.

Keywords

Short cervixCervical insufficiencySingleton pregnancyRisk factorsInvestigationsPreconception counselingPrenatal managementAntepartum preventionIntrapartum preventionTransvaginal sonography, techniqueCerclage: transvaginal, transabdominal, contraindications, patient consent, clinical management, prolapsed amniotic membranespreterm premature rupture of membranes
Type
Chapter
Information
OSCEs in Obstetrics and Maternal-Fetal Medicine
An Evidence-Based Approach
 , pp. 96 - 108
Publisher: Cambridge University Press
Print publication year: 2023

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References

Suggested Readings

ACOG Practice Bulletin No. 142: cerclage for the management of cervical insufficiency. Obstet Gynecol. 2014;123(2 Pt 1):372–379.Google Scholar
(a) Alfirevic, Z, Stampalija, T, Medley, N. Cervical stitch (cerclage) for preventing preterm birth in singleton pregnancy. Cochrane Database Syst Rev. 2017;6(6):CD008991.Google ScholarPubMed
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Conde-Agudelo, A, Romero, R, Nicolaides, KH. Cervical pessary to prevent preterm birth in asymptomatic high-risk women: a systematic review and meta-analysis. Am J Obstet Gynecol. 2020;223(1):42–65.Google Scholar
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Preterm Labour and Birth. NICE Guideline NG25, November 20, 2015, last updated August 2, 2019. Available at www.nice.org.uk/guidance/ng25?unlid=9291036072016213201257. Accessed July 10, 2021.Google Scholar
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Shennan, A, Chandiramani, M, Bennett, P, et al. MAVRIC: a multicenter randomized controlled trial of transabdominal vs transvaginal cervical cerclage. Am J Obstet Gynecol. 2020;222(3):261.e1–261.e9.Google Scholar
(a) Brown, R, Gagnon, R, Delisle, MF. No. 373 – cervical insufficiency and cervical cerclage. J Obstet Gynaecol Can. 2019;41(2):233–247.CrossRefGoogle ScholarPubMed
Lim, KI, Butt, K, Nevo, O, et al. Guideline No. 401: sonographic cervical length in singleton pregnancies: techniques and clinical applications. J Obstet Gynaecol Can. 2020;42(11):1394–1413.Google Scholar
Sperling, JD, Dahlke, JD, Gonzalez, JM. Cerclage use: a review of 3 national guidelines. Obstet Gynecol Surv. 2017;72(4):235–241.Google Scholar

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