A Simple Scoring System for the Treatment of Cervical Incompetence Diagnosed during the Second Trimester

TLDR

The study introduces a cervical incompetence scoring system to aid selection for emergency cerclage in midtrimester patients. Emergency cerclage was performed on 24 women, with appropriateness assessed by the Cervical Incompetence Scale (CIS) that quantifies cervical effacement, dilatation, and membrane protrusion. Patients with low CIS scores (0‑3) experienced significantly better outcomes—fewer complications, lower pregnancy loss, and longer gestation—yielding an 87.5 % success rate when effacement <50 %, dilatation <1.5 cm, and membranes remained in the canal.

Abstract

Twenty-four women with second-trimester cervical incompetence underwent emergency cerclage. The appropriateness of cervical cerclage was analyzed according to a scoring system (Cervical Incompetence Scale; CIS) which measures the degree of cervical effacement, cervical dilatation and protrusion of fetal membranes into the cervical canal. Patients with low CIS (0-3 points) were found to have a more favorable pregnancy outcome than patients with high-score cervical incompetence (5-8 points), i.e. fewer complications following the procedure, 33.3 and 87.5%, respectively, fewer pregnancy losses (22.2 and 75%, respectively) and a significantly prolonged postoperative pregnancy course (mean gestation 33.2 and 24.4 weeks at delivery, respectively). The chances of a successful pregnancy outcome were evaluated at 87.5%; the outcome was successful in patients with low CIS presenting with effacement of the uterine cervix of less than 50%, cervical dilatation of less than 1.5 cm and with fetal membranes remaining in the cervical canal. On the basis of these results, we conclude that the emergency cerclage operation in carefully selected patients with midtrimester cervical incompetence may improve the outcome of pregnancy. This selection is facilitated by the use of a new cervical incompetence scoring system described herein.