The Common Vein Copyright 2010
Definiiton
Cervical insufficiency is a structural problem of the cervix that usually occurs late in pregnancy, but can occur as early as the second trimester.
The cause is often a history of cervical surgery or trauma resulting in early dilation of the cervix in pregnancy.
The structural change is characterized by dilation of the cervix before labor with bulging of the fetal membranes through the cervical os.
The functional changes are characterized by an increase risk of early membrane rupture or intrauterine infection.
Women present clinically during routine examination in pregnancy, and are usually asymptomatic.
Diagnosis is made on physical exam. Imaging with ultrasound will sometimes reveal cervical insufficiency in an asymptomatic woman.
Treatment of women with viable pregnancy can be expectant with steroids for fetal lung maturity and strict bed rest. Women with previable pregnancies may be treated with cerclage, a stitch around the cervix to close the os.