A 29-year-old woman had a painless second-trimester miscarriage in her last pregnancy. In the current pregnancy at 18 weeks, transvaginal sonography shows a closed cervix measuring 18 mm with no contractions and a live fetus. What is the most appropriate management?

• A Ultrasound-indicated cerclage ✓
• B Expectant management with fortnightly cervical length surveillance
• C Arabin pessary with pelvic rest
• D Intramuscular hydroxyprogesterone caproate weekly

Explanation

In a woman with a prior second-trimester painless loss or preterm birth, a cervical length below 25 mm identified before 24 weeks defines the population shown to benefit from ultrasound-indicated cerclage. At 18 weeks with an 18 mm cervix, cerclage is clearly indicated. Expectant surveillance risks repetition of the same silent dilatation and loss. B pessary has not proven superior to cerclage in this setting, and hydroxyprogesterone addresses recurrent spontaneous preterm birth, not a structurally incompetent cervix with prior midtrimester loss.

Reference: RCOG Green-top Guideline No. 60: Cervical Cerclage, 2011 ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.