A 29-year-old G3P0L0 has lost two pregnancies at 17 and 19 weeks, both beginning with painless cervical dilation and bulging membranes, followed by rapid delivery of a live fetus. Transvaginal scan in the current pregnancy at 13 weeks shows a closed cervix 32 mm long. What is the most appropriate management?

• A Elective transvaginal cervical cerclage now ✓
• B Serial cervical length surveillance alone
• C Emergency cerclage when the cervix dilates again
• D Vaginal progesterone 200 mg daily until 34 weeks

Explanation

This is classic cervical insufficiency: recurrent painless midtrimester losses preceded by silent dilation. With such a history, history-indicated elective cerclage placed between 12 and 14 weeks improves outcomes and is superior to waiting for emergency rescue cerclage, which carries higher complication rates. Serial surveillance alone is inadequate after two typical losses, and vaginal progesterone is reserved for a short cervix detected on screening rather than replacing cerclage in this setting.

Reference: Williams Obstetrics, 26th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.