This document discusses short cervix and cervical insufficiency. It defines a short cervix as a cervical length of 10-20mm or less than 25mm measured between 18-24 weeks gestation. Women with a cervix under 15mm before 24 weeks need cervical cerclage placement. Cervical length is best measured via transvaginal ultrasound. Risk factors for cervical insufficiency include DES exposure, uterine anomalies, history of second trimester losses, cervical lacerations or multiple terminations. Management may include cervical cerclage placement before 24 weeks for those with two or more third trimester losses. Health education on cervical changes is also important.

1. SHORT CERVIX AND CERVICAL
INSUFFICIENCY
By Jean Bosco Henri HITAYEZU

2. OBJECTIVES
 At the end of this session student will be able to:
• Define short cervix
• Discuss the significance of cervical length
• Manage the short cervical length
• Define cervical insufficient
• Describe the impact on pregnancy outcome
• Follow the woman with cervical insufficient

3. A. SHORT CERVIX
 Sonographic cervix length of 10 to 20 mm or <25
mm measured at 18-24 weeks’gestation.
 Women with a very short cervix<15mm before 24
GA: need cerclage placement
 Golden standard for cervical length measurement is
Transvaginal ultrasound(TVUS).
 Abdominal ultrasound is not reliable difficulty in
obtaining an appropriate angle.

4. SHORT CERVIX CONT….
 Cervical length may also be measured with
CerviLenz: small disposable device used during
speculum examination.

5. CONTI….
 Cervical length <30 mm is considered as short
 Need medical intervention because high lisk of
preterm labor.
 Vaginal progesterone therapy is needed.

6. B. CERVICAL INSUFFICIENT
 Cervical effacement and dilatation without pain in
second and early third trimester.
 Risk factors:
 Congenital :
 Diethylstilbestrol(DES) exposure
 Congenital anomalies
 Uterine anomalies

7. RISK FACTORS
 Congenital :
 Diethylstilbestrol(DES) exposure
 Congenital anomalies
 Uterine anomalies
 Obstetrics history factors:
 Hx of fetal loss at 14 week’s gestation
 Hx of cervical laceration
 Multiple first or second trimester pregnancy terminations
 Gynecologic History factors:
 Mechanical dilation from curettage or
hysterosalpingogram
 Previous cervical conization with a large amount of
tissue removed.

8. MANAGEMENT
 Women with hx of two or more third trimester losses
need medical consultation.
 Cervical cerclage before 24 week’s gestation.
 Hx of two or more midtrimester losses-need
cerclage placement between 14-18 weeks’gestation
without considering cervical condition.
 Health education about signs and symptoms of
cervical change: pressure, increases discharge,
spotting, cramping. –Return for reassessment

9. IMAGE OF CERVICAL CERCLAGE

10. REFERENCE
 King,L.T ;etal. (2015). Varney's midwifery: 5th
edition.Jones&BatlettLearning.Burlington,MA01803.