Cervical incompetence: a reappraisal of an obstetric controversy.
Cervical incompetence is not a categoric but rather a continuous variable, meaning that there are various degrees in the competency of the cervix. Furthermore, a certain degree of competency of the cervix can be expressed differently in subsequent pregnancies. Women with risk factors for cervical incompetence in their gynecological/obstetric history should be followed by transvaginal ultrasonography. History alone is not an indication for a prophylactic cerclage. Although transvaginal ultrasonography identifies women at high risk of preterm delivery, it does not discriminate between different underlying pathologies. Short cervical length alone is not an indication for a therapeutic cerclage. Serial transvaginal ultrasonographic measurements of cervical length in women with risk factors can identify those women truly at high risk of preterm delivery. A transvaginal cervical cerclage with bed rest reduces preterm delivery and improves perinatal outcome in women with a short cervical length and risk factors for cervical incompetence.


BACKGROUND
Obstetricians & Gynecologists, Family Physicians.


OBJECTIVE
After completion of this article, the reader will be able to define cervical incompetence, explain the role of transvaginal ultrasonography in the prediction of preterm delivery, and summarize the data on the use of transvaginal cervical cerclage.
Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, VU Medical Center, Amsterdam, the Netherlands.
Sietske M
SM
Althuisius
Gustaaf A
GA
Dekker
Herman P
HP
van Geijn
D001510:Bed Rest; D023802:Cerclage, Cervical; D002584:Cervix Uteri / Q000000981:diagnostic imaging; D005260:Female; D006801:Humans; D007752:Obstetric Labor, Premature / Q000517:prevention & control; D011247:Pregnancy; D012307:Risk Factors; D014463:Ultrasonography; D002581:Uterine Cervical Incompetence / Q000000981:diagnostic imaging