When the cervix is unable to hold a pregnancy in the second trimester and there are no contractions, labor, or both.
Cervical insufficiency (previously termed cervical incompetence) is defined as recurrent and painless cervical dilation leading to pregnancy loss typically in the second trimester.
While we addressed the primary cause of unexplained second trimester loss in a previous podcast episode, this is a common explainable reason for pregnancy loss in the second trimester. Cervical weakness or insufficiency may be a result of trauma to the cervix, prior cervical or uterine surgery (eg, LEEP, dilation and curettage, hysteroscopy) or a congenital (birth) abnormality.
Cerclage is a wonderful treatment (both preventative and therapeutic) for cervical insufficiency. In this episode, we review the different types of cerclage and when in a pregnancy they can be placed. A preventative cerclage or a history-indicated cerclage is usually performed at 12 to 14 weeks. Whereas a rescue cerclage and an emergency cerclage are performed later in the second trimester.
The two most common transvaginal techniques for cerclage were described by Shirodkar and McDonald techniques. You can see the video which explains them in more detail.
Dr. Abdelhak explains his rationale for each type of cerclage and when as well as briefly discusses the abdominal cerclage.
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