Cervical insufficiency is painless opening of the cervix in the second trimester without contractions, which can lead to pregnancy loss or very early birth. It is suspected from a history of prior second-trimester losses or a short cervix on ultrasound.
Key symptoms
- Often no symptoms until the cervix is open
- Pelvic pressure or a feeling of heaviness
- More watery or mucous vaginal discharge
- Mild cramping or light spotting
- History of painless loss in the second trimester
What you find on exam
- Speculum exam: cervix dilated or membranes visible
- Membranes bulging at or past the external os
- No regular contractions on palpation or monitoring
- Fetal heart rate and maternal temperature
Tests
- Transvaginal ultrasound: cervical length under 25 mm before 24 weeks
- Tests for infection: urine culture and vaginal swabs
- Rule out rupture of membranes
- Blood count, and amniocentesis if infection is suspected
Treatment basics
- Cerclage (a stitch around the cervix) based on history, ultrasound or exam
- Vaginal progesterone for a short cervix in a singleton pregnancy
- Corticosteroids such as betamethasone if preterm birth is likely after viability
- Pelvic rest and close follow-up
Red flags
- Fever or uterine tenderness suggesting infection
- Leaking fluid or rupture of membranes
- Regular contractions or vaginal bleeding
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Sources: NCCPA PANCE Content Blueprint; NBOME COMLEX-USA clinical presentations; AAMC Core Entrustable Professional Activities (Core EPAs). Written by Making Synapses. Making Synapses is not affiliated with these organizations.