34. Cervical Insufficiency

  1. John T. Queenan MD2,
  2. Catherine Y. Spong MD3 and
  3. Charles J. Lockwood MD4
  1. John Owen MD

Published Online: 4 JAN 2012

DOI: 10.1002/9781119963783.ch34

Queenan's Management of High-Risk Pregnancy: An Evidence-Based Approach, Sixth Edition

Queenan's Management of High-Risk Pregnancy: An Evidence-Based Approach, Sixth Edition

How to Cite

Owen, J. (2012) Cervical Insufficiency, in Queenan's Management of High-Risk Pregnancy: An Evidence-Based Approach, Sixth Edition (eds J. T. Queenan, C. Y. Spong and C. J. Lockwood), Wiley-Blackwell, Oxford, UK. doi: 10.1002/9781119963783.ch34

Editor Information

  1. 2

    Department of Obstetrics and Gynecology, Georgetown University School of Medicine, Washington, DC, USA

  2. 3

    Bethesda, MD, USA

  3. 4

    Department of Obstetrics, Gynecology and Reproductive Sciences, Yale University School of Medicine, New Haven, CT, USA

Author Information

  1. Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, AL, USA

Publication History

  1. Published Online: 4 JAN 2012
  2. Published Print: 24 FEB 2012

ISBN Information

Print ISBN: 9780470655764

Online ISBN: 9781119963783

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Keywords:

  • cervical insufficiency;
  • syndrome of spontaneous preterm birth, anatomic;
  • degrees of insufficiency, and “cervical failure”;
  • cervical insufficiency diagnosis;
  • cervical insufficiency, part of a broader syndrome;
  • “Risk factors” for cervical insufficiency;
  • management of cervical insufficiency;
  • McDonald cerclage, patient in dorsal lithotomy position;
  • ultrasound-indicated versus history-indicated cerclage;
  • cervical insufficiency, functional deficit, the more prevalent etiology

Summary

Although the term “cervical incompetence” was first used in The Lancet in 1865, the contemporary concept was not widely accepted until the middle of the 20th century, after Palmer and Lacomme in 1948 and Lash and Lash in 1950 independently described interval repair of anatomic cervical defects associated with recurrent spontaneous midtrimester birth. Soon thereafter, Shirodkar in 1955, McDonald in 1957, and later Benson and Durfee in 1965 described the cerclage procedures utilized in contemporary obstetric practice. Nevertheless, the literature on cervical insufficiency (the preferred contemporary term) has largely been a chronicle of surgical methods to correct often posttraumatic anatomic disruption of the internal os, in women who had experienced recurrent painless dilation and midtrimester birth. Evidence-based guidelines for many aspects of the diagnosis and management are still lacking.