A 26-year-old G3P0L0 woman lost two pregnancies at 18 and 19 weeks following painless cervical dilatation and spontaneous rupture of membranes. At 13 weeks of the current pregnancy the cervix is closed and measures 35 mm on transvaginal scan. What is the most appropriate management now?

• A Modified bed rest until delivery
• B Serial cervical length scans with cerclage only if length falls below 25 mm before 24 weeks
• C Vaginal micronised progesterone 200 mg daily until 34 weeks
• D History-indicated cerclage placed now ✓

Explanation

Two or more unexplained mid-trimester painless losses are the classic indication for history-indicated cerclage, ideally placed between 12 and 14 weeks. Serial surveillance with rescue cerclage is the strategy for women with a less convincing history or incidental short cervix, not for a classical history like this. Progesterone is adjunctive therapy for short cervix or preterm labour risk, and bed rest has no proven benefit.

Reference: Williams Obstetrics, 26th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.