August 2003 · Vol. 15, No. 8The 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.
JENNIFER
T.
AHN,
MD;
JUDITH
U.
HIBBARD,
MDDr. Ahn is instructor and Dr. Hibbard is professor of obstetrics and gynecology, University of Chicago,
Chicago, Ill.
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KEY POINTS
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An extensive history is essential to identify the gravida at risk for a shortened cervical length.
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Transvaginal measurement of cervical lengths less than 26 mm has a high predictive value for preterm delivery.
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Prophylactic cerclage should be offered to patients with a classic history of cervical incompetence.
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The benefits of therapeutic cerclage for a shortened cervix remain uncertain, especially in women deemed to have a low risk of preterm delivery.
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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.
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