Challenges in preventing preterm birth associated with cervical insufficiency
DOI:
https://doi.org/10.5327/JBG-2965-3711-2024134103%20Keywords:
cerclage cervical, uterine cervical incompetence, pessaries, progesteroneAbstract
Introduction: Cervical insufficiency is a significant risk factor for prematurity, the main cause of perinatal morbidity and mortality. Objective: To review diagnostic criteria and strategies to reduce preterm births associated with cervical insufficiency. Methods: A bibliographic review was conducted using descriptors related to cervical insufficiency on the Pubmed and Virtual Health Library databases, between 2018 and 2023. Results: A total of 69 articles were included. Cervical insufficiency has unclear diagnostic criteria. Current evidence suggests that its diagnosis can be obtained by identifying a suggestive obstetric history, a short cervix (≤25 mm) on ultrasound, or a dilated cervix in the absence of labor in the current pregnancy. In women with a history suggestive of cervical insufficiency, elective cerclage is indicated. In singleton pregnancies undergoing ultrasound surveillance of cervical length between 160/7 and 246/7 weeks, cerclage for a short cervix should be offered. In singleton pregnancies, progesterone is indicated in the history of spontaneous preterm birth, or when a short cervix is observed on transvaginal ultrasound even without a history of previous preterm birth. In patients at usual risk, measurement of the cervix is indicated between 18 and 24 weeks of gestation, during the second trimester morphology ultrasound. There is insufficient evidence to support the use of pessary to prevent preterm birth. In unselected twin pregnancies, there is no evidence for the use of progesterone or cervical cerclage to reduce preterm birth. Conclusion: The decision on the best management to minimize the risk of pregnancy loss associated with cervical insufficiency must be individualized, considering the obstetric history, cervical shortening (or dilation), the experience of the health care team, and the pregnant woman's consent.
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