Ask Dr. Johnson Topic of the Week: Cervical Insufficiency

The term cervical insufficiency is used to describe the inability of the uterine cervix to retain a pregnancy in the absence of contractions and/or labor in the second trimester.

The diagnosis is based on a history of painless cervical dilation after the first trimester (>14 weeks) with pregnancy loss (before 24 weeks). It has to be a painless process, no contractions or labor.

The only treatment option that has proven benefit is cerclage placement (which is a stitch around the cervix).

Any woman that has experienced
• one or more second-trimester pregnancy losses related to painless cervical dilation (no early separation of the placenta)
• Prior cerclage due to painless cervical dilation in the second trimester
• Painless cervical dilation in the second trimester (14-23 weeks)

Any woman that has experienced any of these scenarios should be offered a cerclage. If not, you need to inquire about it.

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