A 29-year-old G4P0L0 has had three consecutive painless midtrimester losses at 17, 18, and 19 weeks, each preceded by silent cervical dilation. She is now pregnant again at 12 weeks; the cervix is 3 cm long and closed. What is the best management?

• A Elective (history-indicated) McDonald cerclage placed at 12 to 14 weeks ✓
• B Vaginal micronized progesterone 200 mg nightly alone
• C Emergency rescue cerclage when dilation is first detected on scan
• D Strict bed rest from 16 weeks with fortnightly scans

Explanation

Three or more prior painless second-trimester losses or preterm births meet the classic indication for history-indicated cerclage, placed electively at 12 to 14 weeks by the McDonald technique. Progesterone alone is insufficient for this degree of prior loss, though it is used for short cervix without such history. Rescue cerclage carries higher morbidity and is for emergency presentation, not prophylaxis.

Reference: Williams Obstetrics, 25th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.