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Cervical insufficiency (incompetent cervix)

Painless early pregnancy dilation

Etiology

  • Trauma from rapid forceful cervical dilation associated with 2nd trimester abortion
  • Cervical laceration from rapid delivery
  • Injury from deep cervical cone
  • Congenital weakness from DES exposure

Diagnosis:


  • History of 2 or more unexplained second trimester pregnancy losses.
  • Benefit of cerclage is unclear  


Management: 


  • Elective cerclage at 13-16 weeks gestation
  • Emergency or Urgent cerclage
  • Cerclage removal at 36-37 weeks