Cervical Insufficiency

Sarnisyah
 Definition
• Cervical insufficiency has no consistent
definition, but is usually characterized by
dilatation and shortening of the cervix before
the 37th week of gestation in the absence of
preterm labour, and is most classically
associated with painless, in the second or
early third trimester.

SOGC Clinical Practice Guidelines, December 2013

 Pathophysiology
• Cervical insufficiency is thought to be related
to a defect in tensile strength at the
cervicoisthmic junction
• Deficiency of cervical collagen, cervical elastin,
or some other structural, mechanical
component of cervical connective tissue that
normally resists softening, effacement, and
dilatation caused by the gravitational effect of
the fetus and amniotic fluid

Midtrimester Loss: The Role of Cerclage and Pessaries in Recurrent Pregnancy Loss. Israel Hendler
and Howard J. A. Carp
 Risk Factor
• Congenital Factors
– Anatomic abnormality (such as congenital
Müllerian anomalies, unification defects (e.g.,
bicornuate uterus), and even arcuate uterus, in
utero diethylstilbestrol (DES) exposure, or collagen
disorders (e.g., Ehlers–Danlos syndrome).
• Acquired Factor
– Obstetric Trauma
– Mechanical Dilatation
Midtrimester Loss: The Role of Cerclage and Pessaries in Recurrent Pregnancy Loss. Israel Hendler
and Howard J. A. Carp
McDonald Cerclage
Modified Shirodkar
Cerclage
Thank You