Clinical aspects of cervical insufficiency.
Fetal loss is a painful experience. A history of second or early third trimester fetal loss, after painless dilatation of the cervix, prolapse or rupture of the membranes, and expulsion of a live fetus despite minimal uterine activity, is characteristic for cervical insufficiency. In such cases the risk of recurrence is high, and a policy of prophylactic cerclage may be safer than one of serial cervical length measurements followed by cerclage, tocolysis and bed rest in case of cervical shortening or dilatation. In low risk cases, however, prophylactic cerclage is not useful. There is a need for more basic knowledge of cervical ripening, objective assessment of cervical visco-elastic properties, and randomized controlled trials of technical aspects of cervical cerclage (e.g. suturing technique).
Lotgering
Frederik K
FK
Department of Obstetrics and Gynecology, 791 Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands. f.lotgering@obgyn.umcn.nl
D023802:Cerclage, Cervical; D002584:Cervix Uteri / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007752:Obstetric Labor, Premature / Q000517:prevention & control*; D011247:Pregnancy; D011256:Pregnancy Outcome; D011263:Pregnancy Trimester, Third; D018566:Pregnancy, High-Risk; D018570:Risk Assessment; D013536:Suture Techniques; D002581:Uterine Cervical Incompetence / Q000175:diagnosis / Q000601:surgery*