Etiologic, diagnostic, and management aspects of patients with isthmic-cervical insufficiency

Isthmic-cervical insufficiency (ICI) is one of the main causes of recurrent miscarriage, leading to an increase in perinatal mortality rates and a deterioration of womens reproductive health. There are currently several methods for diagnosing ICI during pregnancy. In the non-pregnant state, its diagnosis is mainly made retrospectively based on a history of preterm birth due to shortening of the cervix. The main treatment for ICI during pregnancy is cervical cerclage. Despite the well-established technique, this surgical intervention is not always effective for prolonging pregnancy and is associated certain pregnancy risks, including uterine contractions, bleeding, and infection. Cases of cervical rupture after suturing have also been reported, which can ultimately lead to miscarriage or preterm delivery. There have been repeated cases of pregnancy loss in women even after the timely detection of ICI and surgical treatment, suggesting that these women are at risk of miscarriage in the future. For such patients, it is necessary to develop an examination algorithm to identify the various aspects of their cervical insufficiency and treatment at the pregravid stage.