Controversies regarding cervical incompetence, short cervix, and the need for cerclage.
Cervical incompetence (CI) is not an all or nothing phenomenon but a continuous variable. CI and preterm labor are not distinct entities but rather part of a spectrum leading to preterm delivery. Cervical length (CL) is an independent variable in the prediction of preterm delivery, to which it is inversely related. Application of a primary transvaginal cervical cerclage appears to be an unnecessary intervention in about 50% of women presenting with a history suggesting cervical incompetence. A better alternative for women with a history of or risk factors for CI is transvaginal ultrasonographic follow-up of CL. To facilitate the comparison of studies of CI, the authors suggest a nomenclature reflecting the different stages of prevention: primary, secondary, and tertiary transvaginal cervical cerclage.
Althuisius
Sietske
S
Department of Obstetrics and Gynecology, Free University Hospital, De Boelelaan 1117, 1007 MB, Amsterdam, The Netherlands.
Dekker
Gus
G
D023802:Cerclage, Cervical; D002584:Cervix Uteri / Q000000981:diagnostic imaging / Q000601:surgery*; D005260:Female; D006801:Humans; D007752:Obstetric Labor, Premature / Q000517:prevention & control*; D011247:Pregnancy; D013536:Suture Techniques; D016216:Ultrasonography, Prenatal; D002581:Uterine Cervical Incompetence / Q000000981:diagnostic imaging / Q000517:prevention & control*