Midtrimester Loss: The Role of Cerclage and Pessaries

Cervical insufficiency is defined as the inability of the uterine cervix to retain a pregnancy in the absence of contractions or labor. It is a clinical diagnosis characterized by recurrent painless cervical dilatation and spontaneous midtrimester loss of a viable fetus. Generally, in the absence of predisposing conditions, such as spontaneous rupture of the membranes, bleeding or infection, it may indicate a different origin for midtrimester loss rather than primary cervical malfunction or insufficiency.1 Cervical insufficiency was first described in the English literature in 1678; however, even today the diagnosis is clinical and made in retrospect after a poor obstetric outcome. The diagnosis is difficult to make and is solely based upon careful history and review of the medical records, rather than accurate diagnostic imaging studies or other laboratory tools. True cervical insufficiency is probably uncommon; however, the lack of clear diagnostic criteria makes the incidence unknown.