A 32-year-old G5P1 presents for her first prenatal visit. A complete obstetrical, gynecological, and medical history and physical examination is performed.
Which of the following would be an indication for elective cerclage placement?
A. Three spontaneous first-trimester abortionsCervical insufficiency (or incompetence) describes the inability of the cervix to retain a pregnancy in the absence of contractions (or labor) in the second trimester. It is diagnosed based on a history of painless cervical dilation after the first trimester with delivery usually before 24 weeks, without contractions or other clear pathology (ie, infection, ruptured membranes). Based on current data, a shortened cervical length on ultrasound is associated with an increased risk of preterm birth, but is not sufficient for the diagnosis of cervical incompetence. Cerclage is indicated in a patient with a history of one or more second-trimester losses related to cervical incompetence. Cerclage is not indicated for the prevention of first-trimester losses, nor has it been shown to improve the preterm delivery rate or neonatal outcome in twin gestations. Evidence is currently lacking for the benefit of cerclage solely due to a history of prior loop electrosurgical excision procedure or cone biopsy. Serial transvaginal ultrasound evaluation of cervical length can be considered in women with a history of second and early third-trimester deliveries. A cervical length less than 25 mm or funneling of more than 25% or both is associated with an increased risk of preterm delivery.