Evaluation and Management of Short Cervix during Pregnancy

Abstract

Cervical shortening and cervical insufficiency are significant risk factors for spontaneous preterm birth, a leading cause of neonatal morbidity and mortality. Cervical shortening is typically defined as a cervical length of less than 25 mm before 24 weeks of gestation, as measured by transvaginal ultrasound. This condition may reflect underlying structural or functional cervical weakness and is often asymptomatic. Cervical insufficiency, on the other hand, refers to the painless dilatation of the cervix in the absence of contractions or labor, leading to recurrent second-trimester pregnancy losses or early preterm births.
The etiology of cervical insufficiency is multifactorial, including congenital factors, trauma from previous surgical procedures, or biochemical changes in cervical tissue. Diagnosis is primarily clinical but can be supported by imaging and obstetric history. Management strategies include the use of progesterone supplementation, cervical cerclage, and pessary placement, depending on the patient’s risk profile and obstetric history. Timely identification and intervention are critical for improving pregnancy outcomes.
Recent advances in imaging and biomarker research offer potential for earlier and more accurate prediction of cervical dysfunction. However, standardization of screening protocols and individualized management remain challenges in clinical practice. Further research is needed to better understand the