ABSTRACT
Cervical incompetence or (preferably named) cervical insufficiency is defined as ‘the inability of the uterine cervix to retain a pregnancy in the absence of contractions or labor’. It is a clinical diagnosis characterized by recurrent painless cervical dilatation and spontaneous midtrimester loss, generally in the absence of obvious predisposing conditions such as spontaneous membrane rupture, bleeding, or infection, which may indicate other causes of preterm birth rather than cervical insufficiency. Although cervical incompetence was first described in the English language literature in 1678, and great strides have been made in the understanding of this condition, the clinical diagnosis is usually made in retrospect, after a poor obstetric outcome. The diagnosis is difficult to make, and usually depends on a careful history and review of the medical records, rather than accurate diagnostic means or laboratory tests. True cervical insufficiency is probably an uncommon diagnosis; however, the lack of clear diagnostic criteria make the incidence difficult to ascertain objectively. The condition is important, as midtrimester pregnancy loss will ensue or the condition can be part of a spectrum leading to preterm delivery in all stages of the third trimester, with its attendant risks to the infant.
