Cervical insufficiency describes a cervix that shortens or opens too early, sometimes with few symptoms. Risk assessment considers pregnancy history, cervical surgery, ultrasound cervical length and the circumstances of previous losses or preterm birth.
Who may need specialist assessment
Early referral may be appropriate after recurrent mid-trimester losses, very early spontaneous births, previous cervical surgery or a prior cerclage. The detailed sequence of pain, bleeding, contractions, membrane rupture and cervical opening helps distinguish cervical insufficiency from other causes.
Cervical-length surveillance
Transvaginal ultrasound provides the most reliable cervical-length measurement. Serial scans may be offered during the second trimester. A short cervix does not automatically mean a stitch is required; previous history and current findings are considered together.
Progesterone and cerclage
Vaginal progesterone, an ultrasound-indicated cerclage or a history-indicated cerclage may be discussed. The timing, anaesthesia, possible complications and situations in which a stitch is not advisable should form part of consent.
After the procedure
Follow-up focuses on symptoms, infection risk and preterm-labour signs. Routine bed rest is not automatically beneficial and can have harms. Removal timing depends on stitch type and the planned mode of birth.
Questions worth discussing at your consultation
- Which part of my pregnancy history suggests cervical insufficiency?
- Would cervical-length monitoring be enough, or is a stitch recommended?
- What are the alternatives and procedural risks?
- When would the stitch be removed?