Management of painless mid-trimester cervical dilatation: Prophylactic vs emergency placement of cervical cerclage

Women with recurrent painless mid-trimester miscarriages are often diagnosed with cervical insufficiency. Presenting symptoms typically include vaginal pressure and minimal bleeding; when the cervix is examined, advanced dilatation is usually detected. Labour is short and the premature fetus is born alive. Women with this history were traditionally considered candidates for the placement of cervical cerclage. Recently, this practice has been called into question. Rather than routine placement of prophylactic cervical cerclage at 12 - 14 weeks, many patients are followed expectantly with serial sonographic assessments of cervical length. The goal of this update is to review the literature regarding management options of mid-trimester cervical dilatation.