A 27-year-old G3P0 with two prior painless mid-trimester losses presents at 17 weeks with cervical dilatation of 2 cm and bulging membranes on speculum examination. She is afebrile, has no contractions, and fetal membranes are intact. What is the most appropriate next step?

• A Expectant management with bed rest alone
• B Emergency (rescue) cervical cerclage ✓
• C Immediate induction of labor
• D Progesterone supplementation and weekly review

Explanation

Painless cervical dilatation with bulging intact membranes in the mid-trimester defines cervical insufficiency, and when detected before viability with no infection or labor, emergency (rescue) cerclage prolongs pregnancy and improves neonatal survival. Bed rest and progesterone alone are insufficient once the cervix has already dilated, and terminating a potentially viable fetus is inappropriate. Screening for chorioamnionitis should precede the procedure.

Reference: Williams Obstetrics, 26th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.