Cervical Insufficiency & Cerclage

Cervical insufficiency is painless dilation of the cervix in the second trimester, without contractions or labor, that can end in second-trimester loss or very preterm birth. The classic history is an earlier second-trimester loss with painless dilation, or cervical surgery such as a LEEP or cone biopsy. Many patients feel nothing, while some notice pelvic pressure, low back pain, spotting, or a change in vaginal discharge. A transvaginal ultrasound finds the short cervix, a cervical length under twenty-five millimeters before twenty-four weeks. The treatment is mechanical: a cerclage, a stitch placed around the cervix to hold it closed. A history-indicated cerclage is placed at about twelve to fourteen weeks and removed at about thirty-six to thirty-seven weeks, or sooner if labor begins. Vaginal progesterone is an alternative when ultrasound shows a short cervix. After a cerclage, teach the patient to report contractions, leaking fluid, bleeding, fever, or pelvic pressure right away. Contractions with the stitch in place are urgent, because labor against a cerclage can tear the cervix.