Conservative treatment for suspicious cervical insufficiency
Author(s): SHI Chun-yan, Department of Obstetrics & Gynecology, Peking University First Hospital
Pages: 96-99
Year: 2014 Issue: 2
Journal: Chinese Journal of Practical Gynecology and Obstetrics
Keyword: cervical insufficiency; short cervical length; progesterone; cerclage; cervical pessary;
Abstract: A widely agreed-upon definition for the diagnosis of cervical insufficiency has yet to be achieved. The advent of ultrasonic cervical length measurement has added an additional criterion to the definition of cervical insufficiency. During the midtrimester of pregnancy the cervical length shorter than 25 mm by vaginal sonography without uterine contraction is suspicious of cervical insufficiency. Cerclage indicated by ultrasound for women with singleton gestations,no prior preterm birth history is no significant benefit for reduction of the preterm birth rate,however vaginal progesterone,either 90-mg gel or 200-mg suppository,is associated with reduction in PTB and perinatal morbidity and mortality when the CL < 20mm. Either vaginal progesterone or cerclage or cervical pessary are equally efficacious in the prevention of preterm birth in women with a sonographic short cervix in the midtrimester,singletongestation,and previous preterm birth history. The selection of the optimal treatment may depend upon adverse events, cost and patient / clinician preferences.
Pages: 96-99
Year: 2014 Issue: 2
Journal: Chinese Journal of Practical Gynecology and Obstetrics
Keyword: cervical insufficiency; short cervical length; progesterone; cerclage; cervical pessary;
Abstract: A widely agreed-upon definition for the diagnosis of cervical insufficiency has yet to be achieved. The advent of ultrasonic cervical length measurement has added an additional criterion to the definition of cervical insufficiency. During the midtrimester of pregnancy the cervical length shorter than 25 mm by vaginal sonography without uterine contraction is suspicious of cervical insufficiency. Cerclage indicated by ultrasound for women with singleton gestations,no prior preterm birth history is no significant benefit for reduction of the preterm birth rate,however vaginal progesterone,either 90-mg gel or 200-mg suppository,is associated with reduction in PTB and perinatal morbidity and mortality when the CL < 20mm. Either vaginal progesterone or cerclage or cervical pessary are equally efficacious in the prevention of preterm birth in women with a sonographic short cervix in the midtrimester,singletongestation,and previous preterm birth history. The selection of the optimal treatment may depend upon adverse events, cost and patient / clinician preferences.
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