Background: Cervical incompetence (CI) is a major cause of pregnancy loss and preterm delivery.
The management ususally requires the identification of the causes, through relevant evaluation,
followed by the application of an appropriate treatment modality, usually the insertion of the cervical
Objective: To review cervical incompetence – its evaluation and management and highlights an
innovative method for ret-tightening of loose cerclage stitch (Adinma Procedure).
Methods: This review involves a literature search on the internet in relevant journals, textbooks and
Results: The incidence of cervical incompetence in the general obstetrics population ranges from 0.5
– 1%, rising to 8% in women with a history of previous mid-trimester miscarriages. The causes may be
congenital as in Ehlers-Danlos syndrome or Marfan syndrome or acquired from cervical trauma or
intra-amniotic infections. Risk of CI includes recurrent mid-trimester miscarriages; a previous preterm
pre-mature rupture of membranes occurring before 32 weeks of pregnancy; or a previous pregnancy
with cervical length less than 25 mm measured before 27th weeks of gestation; previous history of
cervical trauma; some congenital abnormalities; and polycystic ovary disease. Diagnosis is made from
the assessment of cervical shortening; cervical dilatation in the absence of history of maternal uterine
contractions and mid-trimestral ultrasound measurement of cervical length less than 25mm.
Management usually involve transvaginal cervical cerclage, prophylactic abdominal cerclage when
indicated, and in rare occasions expectant management and the use of vaginal pessaries. Salvage of
cervical cerclage may involve simple re-tightening (Adinma) procedure.
Conclusion: Management of CI involves thorough evaluation to identify the various risk factors and
causes; and the restoration of cervical competence through cervical cerclage procedure. Post
procedure periodic evaluation and re-tightening improves the success of cervical cerclage and overall
ultimate outcome of the pregnancy
Adinma, Joseph Ifeanyi Brian-D
Department of Obstetrics and Gynaecology, Nnamdi Azikiwe University and Teaching Hospital, P.M.B. 5025, Nnewi, Anambra State, Nigeria.
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