Transvaginal scan at 20 weeks in an asymptomatic woman shows a closed cervix measuring 18 mm. She has no prior preterm birth and no prior cervical surgery. What is the most appropriate management?

• A Emergency cerclage
• B Indomethacin tocolysis
• C Reassurance with no intervention
• D Vaginal micronised progesterone ✓

Explanation

Cervical length below 25 mm before 24 weeks defines a short cervix, the strongest predictor of spontaneous preterm birth. In a singleton gestation without prior preterm birth, vaginal progesterone reduces preterm birth and improves neonatal outcome, so it is first-line. Cerclage is reserved for a history-indicated setting with prior loss, or rescue cerclage with dilatation, while indomethacin treats active contractions, not a short cervix alone.

Reference: Williams Obstetrics, 26th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.