Cervical incompetence

Case contributed by Dr Laughlin Dawes

Presentation

Routine anomaly scan at 21/40.

Patient Data

Gender: Female
Ultrasound

A sagittal transvaginal ultrasound image of the cervix at 21 weeks gestation shows funnelling of the proximal cervix, and reduction of the functional length to 10 mm.

Case Discussion

Cervical incompetence is variably defined, however a cervical length of <25 mm is often used. The risk of preterm delivery is inversely proportional to cervical length - 18% for <25mm and 25% for <20mm.

The presence of funnelling is important. Greater than 50% funnelling before 25 weeks is associated with 80% risk of preterm delivery. Patients at high risk for preterm delivery include:

Transvaginal sonography is most commonly used to assess the cervix, however translabial and transperineal techniques have been used.

Management is controversial, with conflicting results, particularly regarding the efficacy of cerclage. Bed-rest, tocolysis, cerclage, and administration of steroids to accelerate fetal lung maturity are all treatment options to be considered. A recent metaanalysis suggests that cerclage is effective in reducing preterm births by 26% in singleton pregnancies.

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Case information

rID: 35946
Case created: 24th Apr 2015
Last edited: 5th Jun 2017
System: Obstetrics
Inclusion in quiz mode: Included

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