ABSTRACT
This chapter discusses the anatomy and physiology of the uterine cervix during pregnancy and focus on the diagnostic and therapeutic challenges of preterm cervical ripening and the role of cerclage in obstetrics. Preterm cervical ripening may lead to cervical insufficiency or preterm delivery. Definitions of cervical insufficiency have been proposed by many authors and vary slightly. Such definitions need to be examined critically, particularly in light of recent observations with ultrasound and results of studies that have reframed the concept of cervical insufficiency. Collectively, these retrospective studies question the accuracy of the diagnosis of cervical insufficiency and/or the effectiveness of cerclage. Acute cervical insufficiency, however, can present with different degrees of severity. Advocates for pessaries to prevent preterm delivery argued that their use should be considered in women with suspected cervical insufficiency because cerclage had been proven to be efficacious in the prevention of preterm birth, and pessaries would not have the complications known to occur with cerclage.
