Cervical Insufficiency Flashcards
How do you define cervical insufficiency?
inability of the uterine cervix to retain a pregnancy in the absence of the signs and symptoms of clinical contractions, or labor, or both in the second trimester (typically before 24 weeks).
How do you counsel a patient with a history of cervical insufficiency?
- Preterm birth occurs at similar gestational age
- Prophylactic cerclage at 13 weeks
- Serial cervical length every 2 weeks starting 16 weeks until 24 weeks
- Expectant management
Who do you consider to be a candidate for an exam indicated cerclage?
- Prior to 24 weeks
- Dilated cervix or bulging membrane on speculum exam
Who do you consider to be a candidate for an history indicated cerclage?
- Patient with history of cerclage in previous pregnancy
- patient with history of preterm birth due to known cervical insufficiency in previous pregnancy
Who do you consider to be a candidate for an ultrasound indicated cerclage?
CL less than 2cm without history of preterm birth
CL less than 2.5cm with history of preterm birth
Who do you consider to be candidate for an abdominal cerclage?
History of failed cervical cerclage
What are the complications from vaginal cerclage?
Bleeding, damage to surrounding organs, infection, rupture of membrane and maintenance of pregnancy to the periviable period
What are the complications from abdominal cerclage?
Bleeding, damage to surrounding organs, infection, rupture of membrane and maintenance of pregnancy to the periviable period including hospitalization for post surgical recovery if not done robotically or with laparoscopy
Describe how you place a McDonald cerclage.
Place speculum and retractor after emptying bladder, use ring forcep to grab anterior lip of cervix and place counterclockwise suture.
How do you counsel about management options for a patient with history of cervical insufficiency?
Expectant management
Prophylactic cerclage
Serial cervical length then cerclage
How do you follow a patient during pregnancy with a history of cervical insufficiency who declines cerclage placement?
Expectant management
Serial cervical length until 24 weeks every 2 weeks and give progesterone
How do you counsel a patient with a history of cervical insufficiency and a short cervix at 18 weeks gestation?
Cerclage.
Do you follow cervical length ultrasounds post cerclage placement? If so, how often?
No.
