Cervical Incompetence

Cervical Insufficiency

Cervical incompetence is more likely when cervical length is less than

A.  25mm

B. 30mm

C. 40mm

D. 35mm

All are true of cervical cerclage except

A. Elective cerclage in multiple gestations
B. Women who have undergone trachelectomy should have abdominal cerclage placement
C. Emergency cerclage may be considered in women in whom the cervix has dilated to < 4 cm without contractions before 24 weeks of gestation
D. Cerclage should be considered in singleton pregnancies if the cervical length is ≤ 25 mm before 24 weeks of gestation

Conservative management of cervical incompetence includes all except

A. Urine for culture and sensitivity and vaginal cultures for bacterial vaginosis at the first visit
B. Serial transvaginal ultrasonography should be performed every 14 days from 16 weeks of gestation onwards
C. Consider use of progesterones in cervical insufficiency
D. Beyond 23 weeks consider the prophylactic use of corticosteroids

Not true of cervical cerclage procedures

A. Hefner cerclage is done in advanced pregnancy when there is little cervix to work with
B. Lash cerclage is performed before pregnancy
C. Shirodkar cerclage is a permanent stitch with absorbable material
D. Wurm’s procedure is treating cervical incompetence during pregnancy in patients who present after 22nd week of gestation

The most common congenital cause of cervical insufficiency is

A. Ehlers-Danlos syndrome
B. Marfan syndrome
C. Mullerian duct abnormalities
D. Ullrich syndrome

All are true of Emergency cerclage Procedure except

A. Done after excluding a rupture of the membranes
B. Filling the bladder with physiological saline in a patient positioned in the Trendelenburg position is useful
C. Amniocentesis is done prior to the procedure to reduce the tension in the fetal membranes that invades the vagina
D. C-reactive protein (CRP) > 15 mg/L) is associated with emergency suture failure

In short

  • Cervical cerclage is done at around 14 weeks pregnancy and the stitch is removed generally after 36 completed weeks.

  • The McDonald procedure places a purse‐string stitch in the stroma of the ectocervix at the level of reflection of the vaginal fornices.

  • The Shirodkar suture maintains a functional internal os which may be important for efficacy

  • Laparoscopic transabdominal cerclage is an invasive trans‐abdominal procedure for the small proportion of women in whom the vaginal procedure is inappropriate.

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