Professional organizations have released guidance on cervical length (CL) screening for preterm birth (PTB) prevention. The finding of a short cervix, irrespective of obstetric history, has been consistently shown to be associated with higher risk for PTB.
Screening in Asymptomatic women
Surveillance in asymptomatic women with prior sPTB
Two thirds of preterm births are spontaneous, and only 10% of births <34 weeks will occur to women with a history of spontaneous preterm birth (sPTB). Few predictive tests are available for PTB prediction, and mid-trimester CL assessment remains the best clinical tool at identifying high-risk women. Women with short cervix and prior sPTB are at highest risk.
ACOG Practice Bulletin 234: Prediction and Prevention of Spontaneous Preterm Birth
ISUOG Practice Guidelines (Updated): Performance of the routine mid-trimester fetal ultrasound scan
Fetal Medicine Foundation Cervical Length Assessment Program
SOGC: Universal Cervical Length Screening
FIGO: Best Practices in Maternal Fetal Medicine
ISUOG: How to Measure Cervical Length
ACOG defines cervical insufficiency as “the 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.” In addition, ACOG separates out indication for cerclage in to 3 categories
Clinically, cervical insufficiency is painless dilation and recurrent mid-trimester losses without signs of preterm labor (PTL), PPROM, or infection. Patient history may include superimposed symptoms (i.e. bleeding, pressure), therefore a judicious review of records is advised. Those with a history of prior preterm birth can benefit from cervical length screening to appropriate guide selected patients for cerclage.
After clinical examination to rule out uterine activity, or intraamniotic infection, or both, physical examination-indicated cerclage placement (if technically feasible) in patients with singleton gestations who have cervical change of the internal os may be beneficial
Routine management of preterm labor should be followed for patients with symptomatic preterm labor
If cervical change, painful contractions, or vaginal bleeding progress, cerclage removal is recommended
ACOG Practice Bulletin 142: Cerclage for the Management of Cervical Insufficiency
Physical Examination–Indicated Cerclage: A Systematic Review and Meta-analysis
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