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Approach to transvaginal sonographic screening of cervical length in singleton pregnancy and management of pregnant people with a short cervix

Approach to transvaginal sonographic screening of cervical length in singleton pregnancy and management of pregnant people with a short cervix

The management of pregnant people with a singleton pregnancy, no prior spontaneous preterm birth, and a short cervix varies among providers. Some offer cerclage when the cervix is very short (eg, <10 or 15 mm). When the cervix is ≤25 mm, we suggest that clinicians discuss the available data and its limitations with the patient and make a shared decision regarding placement of a cerclage. Refer to UpToDate content on second-trimester evaluation of cervical length for prediction of spontaneous preterm birth.

The best approach to pregnant people with a prior spontaneous twin birth is also controversial. Some studies have reported that a prior spontaneous twin birth is associated with an increased risk of spontaneous preterm birth in the subsequent singleton pregnancy. The increased risk appears to be limited to previous twin births <34 weeks. Therefore, if the prior twin preterm birth was ≥34 weeks, some clinicians manage the subsequent singleton pregnancy the same as in patients with no prior preterm spontaneous birth. If <34 weeks, they offer progesterone supplementation and monitor cervical length, as described for singletons. This is the author's approach to monitoring cervical length and management of pregnant people with a short cervix. This remains a controversial area, and variations of this approach exist worldwide.

TVU: transvaginal ultrasound.

* In addition to cervical length screening, an UpToDate author offers vaginal progesterone supplementation beginning at 16 weeks of gestation and continuing through the 36th week of gestation to reduce the risk of recurrent spontaneous preterm birth. In patients who undergo ultrasound-indicated cerclage, the author continues vaginal progesterone through 36 weeks. However, this is controversial. Refer to UpToDate content on progesterone supplementation for reducing the risk of preterm birth.
Adapted from American College of Obstetricians and Gynecologists practice bulletin number 130, October 2012 (reaffirmed 2018). Prediction and prevention of preterm birth.
Graphic 107318 Version 12.0

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