A 27-year-old G4P0L0 has lost three consecutive pregnancies between 16 and 19 weeks, each preceded by painless cervical dilatation and rupture of membranes. She is now pregnant again at 13 weeks with a closed cervix measuring 3 cm. What is the most appropriate intervention?

• A History indicated McDonald cerclage now ✓
• B Serial cervical length scans with cerclage only if it shortens below 25 mm
• C Intramuscular 17 alpha hydroxyprogesterone caproate weekly until 36 weeks
• D Cervical pessary inserted now and removed at term

Explanation

Three or more unexplained second trimester losses or preterm births justify history indicated cervical cerclage placed electively around 12 to 14 weeks, typically by the McDonald technique. Ultrasound indicated cerclage is reserved for a short cervix of 25 mm or less with a prior preterm birth, so waiting for shortening is inappropriate here. Progesterone and pessary are adjuncts or alternatives for lesser histories and do not replace cerclage in this scenario. Cerclage is usually removed at 36 to 37 weeks.

Reference: Williams Obstetrics, 26th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.