Cervical insufficiency

Suganthi*

Senior Staff Nurse, Kauvery Hospital, Salem, Tamil Nadu

*Correspondence

Abstract

A 28-Year-old female, G3A2 at 23 weeks + 5 days gestation, with a history of recurrent cervical insuffiency admitted with USG findings of short cervix with funnelling. Despite cervical encirclage at 15 weeks and Arabin pessary at 20 weeks, patient developed spontaneous preterm labour and underwent Emergency LSCS at 27 weeks. This report highlights clinical presentation, obstetric management, surgical intervention, post -operative ICU care, nursing management and maternal-neonatal outcome of preterm labour.

Key words: Cervical insufficiency; Arabin pessary

Introduction

Cervical insufficiency is painless cervical dilation in the second trimester without contraction, leading to recurrent mid-trimester loss or extreme preterm birth. Commonly associated with prior cervical trauma, D&C or congenital weakness. Despite prophylactic measures like cerclage and pessary, some cares progress to inevitable preterm labour. Multidisciplinary management with steroids, tocolysis, Antibiotics and timely delivery improve maternal-fetal outcomes.

Patient history

Age/Sex28yrs/F
Obstetric scoreG3A2
LMP3-10-2025
EDD10-07-2026

Chief Complaints: Admitted at 23+5 days with USG S/O Short cervix with funnelling. Foetal movements well. No C/O Abdominal pain.

Obstetric history

1st Pregnancy: 17weeks-MTP: Cervical insuffiency-2023

2nd Pregnancy: 17weeks-MTP: Cervical insuffiency-2025

3rd Pregnancy: Present pregnancy: Cervical encirclage at 15 weeks: Arabin pessary inserted at 20 weeks.

Past medical history: K/C/O Type Diabetes mellitus since 3 years on OHA @ Insulin.

Menstrual history: Regular 5/30 days cycle, Normal flew, married since 4.5 years.

Relevant clinical finding

  • On admission: GC – Afebrile, Conscious, No pallor.
  • Vitals: Bp – 90/50 mmHg, HR – 94 /Min, RR – 22/ Minute, Spo2 – 98%
  • Systemic Exam: CVS- S1, S2 (+), RS -B/L, AE (+), PA -UT – Dates: FHR (+)
  • Blood group: A Positive

Relevant investigation

  • USG: short cervix with funneling at 23weeks+5days
  • Routine bloods:
  • High vaginal swab: Sent to rule out infection

Management

  • Antenatal: Admitted on 18/03/2026 treated with IV Antibiotics, antacids, PPIS, oral medication, strict bed rest and catheterisation.
  • Intrapartum: Developed spontaneous labour pain on 15/04/2026.
  • Surgical: Emergency LSCS done on 15/04/2026 at 1:49am under SA Pfannenstiel incision. Delivered live preterm male baby, 980gms, Apgar 6/10 at 1min, 8/10 at 5min. Myomectomy done for 2x1cm fundal subserosa fibroid
  • Postnatal: IV Antibiotics, insulin for DM, Wound Care, DVT prophylaxis

Nursing management

  • Pre-Op: Strict bed rest, FHR monitoring 92hourly, vitals 4th hourly, psychological support for high – risk pregnancy.
  • Intra-Op: Assist in emergency LSCS, neonatal resuscitation team standby.
  • Post-Op: Monitor vitals, I/O Charts, fundal height, lochia, wound site, encourage early ambulation. Blood sugar monitoring and insulin administration as per sliding scale.
  • Baby care: NICU admission for extreme prematurity, explain condition to parents.

Patient outcome

  • Mother: Delivered by emergency LSCS at 27weeks+5days.post-op period uneventful. Vitals stables at discharge-BP 100/70 mmhg wound healthy. Discharged on 21/04/2026 in stable condition.
  • Baby: Line preterm male, 980gms.admitted to NICU for extreme prematurity care.

Discharge advice

  • Advised oral medication including iron supplementations and diabetic drugs and insulin.
  • Counselling provided regarding wound care, warning signs, contraception.
  • Follow-up appointment schedule with gynaecology.

Discussion

This care highlights refractory cervical insufficiency with repeated mid- trimester losses despite prophylactic cerclage and pessary. The patients. delivered at the threshold of viability. Management of followed ACOG guidelines for cervical insufficiency and extreme prematurity requiring strict glycaemic control.

Conclusion

Cervical insufficiency remains a challenging cause of recurrent pregnancy loss and extreme preterm birth. Early diagnosis, cerclage, progesterone and pessary may prolong pregnancy, but some cases are refractory. Multidisciplinary team approach and NICU Backup are critical for managing previable births.

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