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?
Cervical 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.
Uterine bleeding at 12 weeks’ gestation accompanied by cervical dilation without passage of tissue.
Match the description with the correct type of abortion.
Bleeding occurs in about 30% to 40% of pregnancies before 20 weeks’ gestation, with about half of these pregnancies ending in spontaneous abortion. A threatened abortion describes uterine bleeding that occurs without any cervical dilation or effacement. Inevitable abortion occurs when there is bleeding and cervical dilation, with or without rupture of membranes. Incomplete abortion is when only a portion of the products of conception have been expelled, and the cervix remains dilated. In cases where all fetal and placental tissue have been expelled, the cervix is closed, bleeding is minimal, and uterine cramps have ceased, a diagnosis of complete abortion may be made. A missed abortion is one in which fetal death occurs before 20 weeks’ gestation without expulsion of any fetal or maternal tissue for at least 8 weeks thereafter. When a fetus is retained in the uterus beyond 5 weeks after fetal death, consumptive coagulability with hypofibrogenemia may occur. This is uncommon, however, in gestations of less than 14 weeks in duration.
Passage of some but not all placental tissue through the cervix at 9 weeks’ gestation.
Fetal death at 15 weeks’ gestation without expulsion of any fetal or maternal tissue for at least 8 weeks.
Uterine bleeding at 7 weeks’ gestation without any cervical dilation.
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