Cervical insufficiency: diagnostic, preventive and therapeutic aspects

Common attributes of preterm delivery are cervical insufficiency, premature contractions and rupture of membranes. The development of clinical symptom s depends on the cause and dynamics of these factors. Tocolysis has not suc ceeded in prolonging pregnancy in such a way as to decrease the rate of pre maturity. In the future, we must learn to recognize the first symptoms in a reversible instead of in an irreversible phase. The ultrasonographic structure of the cervix (length and funneling) determi nes more than just the clinical findings or the number of contractions the interval until delivery. We found that transvaginal ultrasonography in a st anding position combined with fibronectin improves the prediction of preter m birth in risk groups. There are only a few controlled studies on the prev ention or treatment of cervical incompetence. Among women with bacteriuria, a previous preterm birth and bacterial vaginosis, antibiotic treatment red uces the risk of another such event. On the basis of our own ultrasound normal values we indicate the use of a v aginal pessary. In cases with repetitive preterm labor we recommend a Shiro dkar cerclage. In cases with substantial loss of cervical tissue we recomme nd an abdominal cerclage and in cases with complete dilatation at an early gestational age we recommend "active expectant management" or in cases with multiple pregnancy delayed interval delivery.