A 28-year-old presents with 3 consecutive pregnancy losses, all occurring at 14–18 weeks, each preceded by painless cervical dilation without labour. Her systemic work-up for thrombophilia, antiphospholipid syndrome, thyroid disease, and karyotyping is normal. The most likely diagnosis and primary treatment are:

• A Antiphospholipid syndrome; aspirin and heparin therapy
• B Uterine septum; hysteroscopic resection
• C Recurrent corpus luteum deficiency; progesterone supplementation
• D Cervical incompetence; prophylactic McDonald cerclage at 12–14 weeks ✓

Explanation

Recurrent mid-trimester losses (14–18 weeks) with painless cervical dilation without contractions is the hallmark of cervical incompetence (cervical insufficiency). The diagnosis is clinical based on the history. Prophylactic McDonald cerclage, placed at 12–14 weeks before cervical changes occur, reduces recurrent loss rates significantly. The negative thrombophilia/APS/karyotype/thyroid work-up rules out other causes of recurrent pregnancy loss. Shirodkar cerclage is an alternative technique. Emergency cerclage can be placed if cervical dilation is detected incidentally in the current pregnancy.

Reference: Williams Obstetrics, 26th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.