Cerclage for the Management of Cervical Insufficiency: A Review

Cervical insufficiency (CI) is classically characterized as painless dilation of the uterine cervix in the second trimester that results in delivery of the pregnancy, typically prior to 24 weeks’ gestation. Treatment of the condition has centered on prevention of recurrence in women with a history of CI or early preterm birth. Universal screening tools for CI in women without a history of prior PTB are lacking. Cervical change that is painless may occur with minimal symptoms such as increasing of vaginal discharge/mucous, vaginal pressure or fullness; many women and their providers can dismiss pathologic symptoms that would otherwise be benign in women without CI. The management of CI is categorized as surgical vs. nonsurgical. The cornerstone of surgical management is composed of cervical cerclage, and may be placed by a transvaginal or transabdominal approach depending on the obstetric history. Nonsurgical management includes pessary or activity restriction. For women who have experienced a midtrimester loss due to suspected cervical insufficiency, postnatal or preconception consultation is essential to identify modifiable risk factors, collect medical records of the delivery, and review pathology results if available.