Author(s): Ryszard Czajka, Rafa? Rzepka
Cervical insufficiency (cervical incompetence, isthmo-cervical insufficiency) is an inability of uterine cervix to pregnancy maintenance until the term of labor caused by cervix dysfunction or morphological anomaly. However, the causes of cervical insufficiency are still not explained. Cervical trauma, congenital factors, functional insufficiency and multiple-pregnancy are acknowledged as the most important. The diagnosis of cervical insufficiency is based on patient’s obstetrical history, physical examination and ultrasound. Diagnostic criteria of cervical insufficiency are shortening and dilatation of the cervix as well as prolapse of the bottom pole of fetal membranes into the cervical canal and vagina parallel to typical ultrasound symptoms (cervical canal length <25 mm, U-shaped dilatation of internal ostium of the uterus, percentage of tunnelization more than 50%). The treatment of cervical insufficiency contains cervical cerclage. Cervical cerclage is placed in two situations – as a prophylaxis and as an urgent, therapeutic cerclage. In the light of Evidence Based Medicine indications for cervical insufficiency treatment and its efficacy are controversial.