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Controversies regarding cervical incompetence, short cervix, and the need for cerclage.

Althuisius S, Dekker G

Department of Obstetrics and Gynecology, Free University Hospital, De Boelelaan 1117, 1007 MB, Amsterdam, The Netherlands.

Cervical incompetence (CI) is not an all or nothing phenomenon but a continuous variable. CI and preterm labor are not distinct entities but rather part of a spectrum leading to preterm delivery. Cervical length (CL) is an independent variable in the prediction of preterm delivery, to which it is inversely related. Application of a primary transvaginal cervical cerclage appears to be an unnecessary intervention in about 50% of women presenting with a history suggesting cervical incompetence. A better alternative for women with a history of or risk factors for CI is transvaginal ultrasonographic follow-up of CL. To facilitate the comparison of studies of CI, the authors suggest a nomenclature reflecting the different stages of prevention: primary, secondary, and tertiary transvaginal cervical cerclage.

Published 2 November 2004 in Clin Perinatol, 31(4): 695-720, v-vi.
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