|August 2003 · Vol. 15, No. 8
The short cervix in pregnancy: Which therapy reduces preterm birth?
Unfortunately, the literature on optimal management is full of conflicting reports. Here, the authors analyze the best data available and offer a detailed management algorithm.
Dr. Ahn is instructor and Dr. Hibbard is professor of obstetrics and gynecology, University of Chicago,
An extensive history is essential to identify the gravida at risk for a shortened cervical length.
Transvaginal measurement of cervical lengths less than 26 mm has a high predictive value for preterm delivery.
Prophylactic cerclage should be offered to patients with a classic history of cervical incompetence.
The benefits of therapeutic cerclage for a shortened cervix remain uncertain, especially in women deemed to have a low risk of preterm delivery.
You are in your busy office, running behind schedule, when you receive a frantic notice from the ultrasound department that your patient—a primigravida scheduled for a routine anatomy survey at 21 weeks’ gestation—has a cervical length of 19 mm with funneling. What are your management options if the patient reports no contractions or changes in vaginal discharge?
With today’s emphasis on evidence-based medicine, it often is difficult to decide on an appropriate course of action, especially when conflicting reports abound. This article reviews the best studies available and presents a practical algorithm (FIGURE 1) to guide management of this difficult dilemma.