Cervical Insufficiency: Pathogenesis and clinical findings
Cervical lacerations
Cervical loop Cone biopsy electrosurgical
procedure excision procedure
Cervical procedures
Post-procedure cervical re-modelling
↓ Structural collagen in extracellular matrix
Opened cervix allows for ↑ voiding of vaginal skin cells, bacteria, mucous and fluid
Fetal head moves lower into pelvis, exerting pressure on pelvic ligaments
Hysteroscopy dilatation and curettage
Antepartum Sterile intra-amniotic infection inflammation
Inflammatory cascade within cervix
↑ Local myometrial and cervical prostaglandins/ cytokines
↑ Collagenase
and leukocyte elastase increases break down of collagen
Congenital abnormality of collagen synthesis
Ex. Ehler-Danlos syndrome
↑ Vaginal discharge
Change in color of vaginal discharge
Braxton-Hicks-like contractions
Menstrual-like cramps
Back ache
↓ Cervical tensile strength and rigidity
Cervical Insufficiency
Spontaneous dilation and thinning of cervix
Unknown cause
Prolapsed fetal membranes
Second trimester loss or preterm birth
Risk of recurrent second trimester loss or preterm birth
Authors: Kiera Pajunen
Reviewers: Ran (Marissa) Zhang Brianna Ghali Ingrid Kristensen* * MD at time of publication
Debris seen in amniotic fluid on U/S
Short cervix (<2.5cm on trans-vaginal ultrasound) Legend: Pathophysiology Mechanism Sign/Symptom/Lab Finding Complications Published July 5, 2022 on www.thecalgaryguide.com