Abstract
Cervical insufficiency is a mid-trimester clinical diagnosis that may include elements of the obstetric history (in multiparous women), sonographic cervical length measurement, and physical examination findings. By definition, the concept of insufficiency denotes early pathologic cervical changes, but it also provides evidence that preterm parturition has begun. Traditionally the standard treatment for insufficiency has been cerclage, placed transvaginally in nearly all cases, with the abdominal approach reserved for special situations. Although cerclage has been proven effective at prolonging gestation in properly selected women, other features of the spontaneous preterm birth syndrome, when concurrent, will limit its effectiveness.
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