Relationship between tumor necrosis factor-alpha genotype and success of emergent cerclage

The guanine to adenine substitution at the -308 position in the tumor necrosis factor-alpha (TNF-alpha) gene promoter region results in a 5-fold greater cytokine response to an inciting event. We investigated whether this polymorphism is associated with cervical incompetence and adverse pregnancy outcome after emergent cerclage. Women with a diagnosis of cervical incompetence requiring an emergent cerclage between 15 and 24 weeks were enrolled. Women without pregnancy complications were recruited as controls. DNA extraction from peripheral blood and polymerase chain reaction (PCR) amplification of a 144-base pair segment of the TNF-alpha gene were performed with subsequent sequencing. Twenty-three women underwent emergent cerclage and participated in the study, 13 (57%) of whom delivered after 28 weeks. Twenty-three women served as controls. There were no differences in the TNF-alpha polymorphism between women with cervical incompetence and controls or between women with cervical incompetence who delivered before versus after 28 weeks. The TNF-alpha polymorphism was not associated with cervical incompetence or with delivery prior to 28 weeks in women who received an emergent cerclage.     

宫颈环扎术在早产治疗中的应用

目的评估治疗性宫颈环扎术及预防性宫颈环扎术的效果。方法选择2003年1月至2006年3月北京大学第三医院的34周前的早产临产及宫颈机能不全患者,早产临产患者采取紧急宫颈环扎术联合宫缩抑制剂或者单纯使用宫缩抑制剂治疗。宫颈机能不全患者采取预防性宫颈环扎术、紧急环扎术以及非环扎保守治疗。对治疗结局进行统计学分析。结果在早产临产组,紧急宫颈环扎联合宫缩抑制剂（硫酸镁）来治疗早产,平均保胎天数45.00 d,较单纯用宫缩抑制剂硫酸镁抑制宫缩的34例患者保胎天数[中位数为1（0.75-16）d]明显延长,34、37周后分娩率分别为66.7%（26/39）、30.8%（12/39）,明显增加。宫颈机能不全患者预防性环扎及治疗性环扎均较非环扎组保胎天数延长,增加32、34周后的分娩率（P〈0.05）,但治疗性环扎可降低早产率（P=0.02）。结论观察资料结果显示早产临产患者硫酸镁联合宫颈环扎治疗早产效果更佳,增加34周以上的分娩率,降低早产率;预防性环扎不能降低37周前早产率,但能增加32、34周后分娩率,延长保胎天数;治疗性环扎可降低37周前早产率。     

Final results of the Cervical Incompetence Prevention Randomized Cerclage Trial (CIPRACT): therapeutic cerclage with bed rest versus bed rest alone.

OBJECTIVE: To compare preterm delivery rates (before 34 weeks of gestation) and neonatal morbidity and mortality in patients with risk factors or symptoms of cervical incompetence managed with therapeutic McDonald cerclage and bed rest versus bed rest alone. STUDY DESIGN: Cervical length was measured in patients with risk factors or symptoms of cervical incompetence. Risk factors for cervical incompetence included previous preterm delivery before 34 weeks of gestation that met clinical criteria for the diagnosis of cervical incompetence, previous preterm premature rupture of membranes before 32 weeks of gestation, history of cold knife conization, diethylstilbestrol exposure, and uterine anomaly. When a cervical length of <25 mm was measured before a gestational age of 27 weeks, a randomization for therapeutic cerclage and bed rest (cerclage group) or bed rest alone (bed rest group) was performed. The analysis is based on intention to treat. RESULTS: Of the 35 women who met the inclusion criteria, 19 were allocated randomly to the cerclage group and 16 to the bed rest group. Both groups were comparable for mean cervical length and mean gestational age at time of randomization, mean overall 20 mm and 21 weeks. Preterm delivery before 34 weeks was significantly more frequent in the bed rest group than in the cerclage group (7 of 16 vs none, respectively; P =.002). There was no statistically significant difference in neonatal survival between the groups (13 neonates survived in the bed rest group vs all in the cerclage group). The compound neonatal morbidity, defined as admission to the neonatal intensive care unit or neonatal death, was significantly higher in the bed rest group than in the cerclage group (8 of 16 vs 1 of 19, respectively; P =.005; RR = 9.5, 95% CI, 1.3-68.1). CONCLUSIONS: Therapeutic cerclage with bed rest reduces preterm delivery before 34 weeks of gestation and compound neonatal morbidity in women with risk factors and/or symptoms of cervical incompetence and a cervical length of <25 mm before 27 weeks of gestation.     

The effect of second trimester emergency cervical cerclage on perinatal outcome

Objective: To evaluate the effectiveness of emergency cervical cerclage and to determine predictors of failure or success in women with cervical incompetence. Methods: Medical records were reviewed for clinical and demographic data, gestational age at time of cerclage, cerclage–delivery interval, gestational age at time of delivery; and birth weight. Predictors of success and failure were analyzed. Result: Forty-three pregnant women between 18 and 25 weeks of gestation were recruited. The mean gestational age at time of cerclage was 21 weeks. The mean cerclage–delivery interval was 64 days. The mean gestation at delivery was 31 weeks and the mean neonatal birth weight was 2166 g. Whether cerclage done before or after 20 weeks, the difference in cerclage–delivery interval was insignificant while the difference in gestational age at time of delivery and neonatal birth weight was significant. Presence of infection, presence of symptoms, membranes through the cervix and dilated cervix >3 cm are frequently associated with failure. Conclusion: Emergency cervical cerclage is effective in prolonging pregnancy and improving neonatal outcome in patient with cervical incompetence. However, large prospective randomized controlled studies are recommended.     

Factors associated with success of emergent second-trimester cerclage

OBJECTIVE: To assess the factors associated with delivery greater than or equal to 28 weeks' gestation after placement of an emergent cerclage in women with singleton gestations. METHODS: All women who underwent emergent cerclage, defined as any cerclage placed between 16 and 24 6/7 weeks' gestation in response to documented cervical change on physical examination, at Northwestern Memorial Hospital from 1980 to 2000 were identified. Univariable and multivariable analyses were used to determine the factors most associated with achieving at least 28 weeks' gestation. RESULTS: One hundred sixteen women were eligible for analysis. Maternal age, race, and operative variables such as suture type and use of antibiotics were not associated with differences in the frequency of delivery at or after 28 weeks. Cerclage placement at or after 22 weeks' gestation increased the likelihood of reaching 28 weeks, whereas several cervical examination findings (dilatation greater than 3 cm, cervical length less than 0.5 cm, and membranes prolapsing beyond the external cervical os) as well as need for placement in a nullipara significantly reduced the likelihood of reaching 28 weeks. In multivariable analysis, nulliparity (odds ratio 0.31, 95% confidence interval 0.1, 0.8) and membranes prolapsing beyond the external cervical os (odds ratio 0.24, 95% confidence interval 0.1, 0.4) continued to be associated with delivery before 28 weeks, whereas cerclage placement at or after 22 weeks (odds ratio 3.2, 95% confidence interval 1.2, 8.6) increased the chance of achieving at least 28 weeks' gestation. CONCLUSION: Nulliparity, the presence of membranes prolapsing beyond the external cervical os, and gestational age less than 22 weeks at cerclage placement are associated with decreased chance of delivery at or after 28 weeks after emergent cerclage; these factors may be used to help counsel patients considering the procedure.     

孕期不同指征经阴道宫颈环扎术的效果评价

目的:回顾性分析孕期3种不同指征经阴道宫颈环扎术的妊娠结局和新生儿预后。方法:收集66例采用Mc Donald方法进行宫颈环扎术患者的临床资料。结果:病史指征性环扎组与超声指征性环扎组,在平均分娩孕周、活产率及新生儿平均出生体质量方面差异均无统计学意义(P0.05)。紧急性环扎组的分娩孕周(29.17±6.44)周均低于病史指征性环扎组的(34.06±6.66)周和超声指征性环扎组的(35.42±4.75)周,差异有统计学意义(P0.05)。紧急环扎组中手术失败孕妇在宫口开大程度、术后白细胞计数及C反应蛋白(CRP)最高值较手术成功孕妇高。结论:病史指征性环扎术和超声指征性环扎术均可获得良好的相似妊娠结局。术后加强抗炎可提高紧急性环扎手术的成功率。剖宫产再孕者有一定的发生宫颈机能不全的概率,孕期应B超监测宫颈的变化。     

Transvaginal ultrasonography of the cervix length and the prediction of preterm delivery

OBJECTIVE: To determine if cervical shortening between 12 and 28 weeks gestation predicts risk of spontaneous preterm birth or cervical funneling requiring cerclage. STUDY DESIGN: We reviewed retrospectively all the patients who had transvaginal cervical ultrasound assessment during one year. 43 patients who had a second and early third trimester delivery or cerclage placement were chosen for the study. The control group consisted of 78 patients without signs of preterm labor and cervical shortening as assessed by transvaginal ultrasound. The results of the last ultrasound cervical length measurement were correlated with the likelihood of preterm delivery or cervical funneling requiring cerclage. RESULTS: 26 of 121 patients studied delivered preterm and 15 required cervical cerclage because of cervical shortening and funneling. The mean cervical length assessed by ultrasound was 23.22 +/- 3.07 mm in the group with preterm contractions and delivery and 21.99 +/- 7.05 mm in the group with cervical incompetence. In the normal pregnancy group mean cervical length was 35.59 +/- 3.07 mm. CONCLUSIONS: Cervical length of < 3.0 cm and further shortening of the cervix is predictive of preterm delivery or cervical incompetence requiring cerclage.     

Cervical incompetence: elective, emergent, or urgent cerclage.

OBJECTIVE: We define criteria for insertion of cervical cerclage done electively (historical), urgently (in patients without symptoms), or emergently (in patients with symptoms). We compare outcomes as determined by prolongation of pregnancy and survival in each of these groups, and we define whether urgent or emergent cerclage imparted a higher risk of spontaneous rupture of membranes or chorioamnionitis than that associated with elective cerclage. Study Design: This is a retrospective analysis of all cervical cerclages placed at Memorial Medical Center between January 1, 1993, and December 31, 1997. Outcomes oberved were as follows: (1) prolongation of pregnancy in weeks after cervical cerclage, (2) presence of spontaneous rupture of membranes or clinical chorioamnionitis necessitating delivery, and (3) neonatal outcome. RESULTS: For prolongation of pregnancy the following results were obtained: emergent cerclage, 8.3 +/- 0.9 weeks; urgent cerclage, 12.2 +/- 1.5 weeks; and elective cerclage, 20.2 +/- 0.9 weeks (elective versus emergent and urgent, P <.05). For average gestational age at delivery, the results were as follows: emergent cerclage, 30.5 +/- 0.9 weeks; urgent cerclage, 33.1 +/- 1.4 weeks; and elective cerclage, 35.5 +/- 0.9 weeks (elective versus emergent and urgent, P <.05). The total neonatal survival was 85.7%. The incidence of spontaneous rupture of membranes was as follows: emergent cerclage, 51%; urgent cerclage, 40%; elective cerclage, 18% (elective versus emergent and urgent, P <.05). The incidence of clinical chorioamnionitis showed similar results. CONCLUSIONS: It is clear that emergency cerclages confer some benefit in patients with evidence of cervical incompetence. From this study it is evident that there is a new group of patients who need cerclage on an urgent basis as shown by subtle ultrasonographic changes in the cervix. Their behavior mirrors that of those belonging to the emergent group, suggesting that if they were left untreated they would need cerclage on an emergency basis.     

紧急宫颈环扎术的指征与注意事项

紧急宫颈环扎术术后安胎成功率可高达72.72%,是宫颈机能不全者治疗不及时的一种有效补救措施。但如不能正确把握其手术时机、掌握手术指征,术后亦可带来严重并发症。因此,严格掌握紧急宫颈环扎术的手术指征,注意术中操作及术后监测,是提高紧急宫颈环扎术成功率的关键。     

Ultrasonic assessment of cervix in 'at risk' patients

One hundred and fifteen women were considered to be at risk of cervical incompetence, judging from their previous history. They were scanned serially from the first trimester to 32 weeks of gestation. Of the 115, 75 women were found to have defective cervix, as assessed on the basis of its length, its overall width and the width of the cervical canal at the level of the internal cervical os, and herniation of the amniotic membrane, with or without fetal parts, into the cervical canal. Sixteen of the 75 women with ultrasonically diagnosed cervical incompetence aborted, 40 needed cervical cerclage, 24 gave birth premature (24 to 34 weeks). Of the 115 women, 40 did not have ultrasonic evidence of cervical incompetence and only one patient gave birth at 36 weeks' gestation, while 39 patients gave birth between 37 and 42 weeks. These 40 women would have had cervical cerclage on the basis of clinical history alone. Ultrasound is an objective method of diagnosing the incompetent cervix and also helps to avoid unnecessary cerclage operations on the basis of history alone.     

The prevalence and timing of cervical cerclage placement in multiple gestations.

OBJECTIVES: To investigate the prevalence and timing of cervical cerclage placement in multiple gestations. METHODS: Our perinatal database was queried for all multiple gestations delivered at Evanston Hospital from 12/95 through 12/00. This list was then cross-matched with billing and medical records for 'incompetent cervix' and 'cerclage.' The medical records of all deliveries /=14 weeks over a 5-year period. The number of patients that underwent cerclage placement was 29 or 3.6%. The mean gestational age at cerclage placement was 18.6+/-4.5 weeks (range 11-24.6). Twelve were elective or prophylactic while 17 were 'urgent' or 'emergent.' The mean gestational age for the 17 emergent cerclages was 21.4+/-2.2 weeks (range 16.6-24.6). When compared with those patients who did not undergo cerclage placement, there was no difference in maternal demographics including age, parity, or previous full-term delivery. There was a significant difference in the gestational age at delivery for the cerclage vs. no cerclage group; 29.3+/-5.6 vs. 34.4+/-4.6 weeks, respectively, and in the frequency of losses at 相似文献   

Predicting outcome after emergent cerclage using classification tree analysis

We sought to develop a predictive model for gestational age at delivery after placement of an emergent cerclage in the second trimester. Data were obtained for women undergoing emergent cerclage in response to documented cervical change on physical examination at a university hospital between 1980 and 2000. Hierarchically optimal classification tree analysis (CTA) was used to predict delivery prior to 24 weeks, between 24 and 27 6/7 weeks, or after 27 6/7 weeks. One hundred sixteen women were available for analysis. Delivery prior to 24 weeks was best predicted by presence of prolapsed membranes and gestational age at cerclage placement; delivery between 24 and 27 6/7 weeks was best predicted by parity alone; delivery of at least 28 weeks was best predicted by cervical dilation and length, presence of prolapsed membranes, and parity. When choosing a single model to predict delivery at the three different gestational age periods, the last model yielded the most accurate results. CTA can be used to construct a predictive model for outcome after emergent cerclage that may be informative for both patients and physicians.     

减胎术联合宫颈环扎术治疗多胎妊娠并宫颈机能不全2例临床分析

多胎妊娠、宫颈机能不全等均是流产或早产的高危因素,若多胎妊娠患者合并宫颈机能不全则流产或早产的风险更高。现报道2例多胎妊娠合并宫颈机能不全患者,分别在孕11+5周和20+5周行减胎术,随后分别在13+4周和21+6周行宫颈环扎术,定期产检阴道超声监测宫颈长度并及时预防早产治疗,分别在孕36周和孕33+4周成功顺产活婴,认为减胎术是多胎妊娠改善妊娠结局的补救措施,减胎术后行宫颈环扎术可修复宫颈的机能,而定期随访对防治早产、指导临床用药及适时拆除宫颈环扎线并改善母儿预后至关重要。当多胎妊娠合并宫颈机能不全时,采用减胎术联合宫颈环扎术进行治疗是一个可供临床借鉴的选择方案。     

Cervical incompetence in multifetal gestation: diagnosis and prophylaxis

OBJECTIVE: Preterm birth following cervical incompetence threatens infants of multiple gestation. The questions at hand are whether we can validate a sonographic early detection system and if prophylactically intended strategies, such as cervical cerclage, potentially influence pregnancy management and/or perinatal outcome. METHODS: Multifetal pregnancies surveyed with three-dimensional ultrasound and pregnancies treated with cervical cerclage were compared to controls. RESULTS: Volumetry of the cervix was possible in all 34 examinations performed. In contrast, two-dimensional cervical length assessment could not be obtained in 6% because the presenting fetal part obstructed the sonographic plane. Mean cervical length was 28.7 mm (SD 7.7). Mean cervical volume was 30.0 cm3 (SD 16.0). A significant correlation was found between mean two-dimensional cervical length and mean cervical volume as both parameters decreased with gestational age (p = 0.01). Prophylactic cervical cerclage was used in 17% of triplet pregnancies studied at a mean gestational age of 16 + 2 weeks (98-138 days). In 50% of the quadruplet/quintuplet pregnancies studied, the cerclage was performed at a mean gestational age of 15 + 2 weeks of gestation (78-152 days). The time interval from operation to delivery was 106 days (62-119) for triplets and 96 days (57-142) for quadruplets/quintuplets. Prophylactic cervical cerclage did not prolong pregnancies compared to controls. With respect to the need for hospitalization or intravenous tocolysis or perinatal outcome parameters, no benefit was achieved. CONCLUSIONS: The results disclaim a positive impact of prophylactic cervical cerclage on the course of a multifetal pregnancy and/or perinatal outcome. On the other hand, early non-invasive diagnosis of cervical incompetence enables a risk-adapted conservative pregnancy management.     

Noninvasive cerclage for the management of cervical incompetence: a prospective study

Objective: The aim of this study was to evaluate the efficacy and safety of a noninvasive cerclage pessary in the management of cervical incompetence. Methods: This is a prospective cohort study of all pregnant women treated for cervical incompetence during a 4-year period. Women with known risk factors for preterm delivery had transvaginal ultrasonography every 2–3 weeks after 17–19 weeks of gestation. Those with progressive shortening of cervix diagnosed before 30 weeks were treated with a cerclage pessary when the cervical length was ≤25 mm. The pessary was electively removed at 34–36 weeks. The course and outcome of pregnancy were recorded. Results: Thirty-two women were treated with a cerclage pessary. There were nine twin and two triplet pregnancies. Fifteen (47%) had two or more risk factors for preterm delivery. The mean gestational age at cerclage was 23 (17–29) weeks, cervical length 17 (5–25) mm. Two women required delivery before the onset of labor due to severe intrauterine growth restriction and one due to HELLP syndrome. These were excluded from further analysis. In the remaining 29 women, the interval between cerclage and delivery was 10.4 (2–19) weeks, mean gestational age at delivery 34 (22–42) weeks, and birth weight 2,255 (410–4,045) g. Thirteen (45%) women delivered before 34 weeks. There were a total of 35 live-born infants and four intrapartum fetal deaths (all between 22 and 25 weeks gestation). All women complained of increased vaginal discharge, but no other significant complications were observed that could be attributed to the use of pessary. Conclusion : Cerclage pessary may be useful in the management of cervical incompetence. Whether it can be a noninvasive alternative to surgical cerclage merits further investigation.     

Cervical incompetence prevention randomized cerclage trial: emergency cerclage with bed rest versus bed rest alone

OBJECTIVE: The purpose of this study was to compare preterm delivery rates and neonatal morbidity/mortality rates for women with cervical incompetence with membranes at or beyond a dilated external cervical os that was treated with emergency cerclage, bed rest plus indomethacin, versus just bed rest. STUDY DESIGN: Women with cervical incompetence with membranes at or beyond a dilated external cervical os, before 27 weeks of gestation, were treated with antibiotics and bed rest and randomly assigned for emergency cerclage and indomethacin or bed rest only. RESULTS: Twenty-three women were included; 13 women were allocated randomly to the emergency cerclage and indomethacin group, and 10 women were allocated randomly to the bed rest-only group. Gestational age at time of randomization was 22.2 weeks in the emergency cerclage and indomethacin group and 23.0 weeks in the bed rest-only group. Mean interval from randomization until delivery was 54 days in the emergency cerclage and indomethacin group and 20 days in the bed rest-only group (P=.046). Mean gestational age at delivery was 29.9 weeks in the emergency cerclage and indomethacin group and 25.9 weeks in the bed rest-only group. Preterm delivery before 34 weeks of gestation was significantly lower in the emergency cerclage and indomethacin group, with 7 of 13 deliveries versus all 10 deliveries in the bed rest-only group (P=.02). CONCLUSIONS: Emergency cerclage, indomethacin, antibiotics, and bed rest reduce preterm delivery before 34 weeks compared with bed rest and antibiotics alone.     

腹腔镜下宫颈环扎术治疗宫颈机能不全16例临床分析

目的探讨腹腔镜下宫颈环扎术治疗宫颈机能不全的效果和安全性。方法对2008年8月至2011年12月中山大学附属第一医院妇科16例经阴道宫颈环扎手术失败和无法行经阴道宫颈环扎术的宫颈机能不全患者,在非孕期行腹腔镜下宫颈环扎术,观察术后妊娠情况。结果 16例患者手术过程均顺利,无一例中转开腹。有10例患者妊娠,其中8例孕足月剖宫产,1例孕31周剖宫产分娩,1例妊娠20周时因胎膜早破导致难免流产,开腹手术剪断环扎带后经阴道娩出胎儿。行剖宫产患者平均分娩孕周为37.9周,较术前平均流产孕周平均延长17.9周。另6例患者中5例现术后1～3个月,尚未计划妊娠,1例术后1+年,未避孕未孕。结论腹腔镜下宫颈环扎术安全有效,可明显延长妊娠时间,增加活产率,可作为宫颈机能不全的治疗方法之一。     

Elective and emergency transabdominal cervicoisthmic cerclage for cervical incompetence

OBJECTIVE: To evaluate the success rate of transabdominal cervicoisthmic cerclage (TACIC) as an elective and emergency procedure for cervical incompetence in comparison to reported success rates for vaginal cerclage. STUDY DESIGN: Retrospective review was performed of the hospital records of patients and their neonates who underwent TACIC for cervical incompetence by the Maternal-Fetal Medicine Service, Harrisburg Hospital. Data regarding procedure indications, maternal age, gravidity/parity, gestational age at time of placement, pregnancy outcome, delivery age and fetal weight at delivery were recorded. Comparison was made to previously reported outcomes for vaginal cerclage. RESULTS: Thirteen patients underwent TACIC from July 1996 through April 2001. The overall viable delivery rate was 76.9%. Five procedures were emergency, with a viable delivery rate of 60%. Mean gestational age at delivery for this group was 34.6 weeks. The 8 elective procedures had a viable delivery rate of 87.5% and mean gestational age of 35.5 weeks. Complications from the TACIC procedure were limited to a single catheter-related urinary tract infection. CONCLUSION: In pregnancies complicated by cervical incompetence and in which Shirodkar or McDonald cerclage has previously failed or is not technically feasible, TACIC offers the possibility of a successful outcome in elective and emergency settings similar to that previously reported for vaginal cerclage.     

Cervical cerclage and evidence-based medicine: if, how and when

Cervical cerclage has always been the main treatment option in cases of so-called cervical insufficiency, a condition that is notoriously associated with a high risk of second trimester abortion and/or preterm delivery. We can distinguish between a prophylactic cerclage, to be performed electively, usually at 13-16 weeks gestation, only when the woman has a history extremely suggestive for cervical incompetence (3 or more mid-trimester abortions or preterm deliveries) and a therapeutic cerclage. This last cerclage is recommended either for women who have ultrasonographic changes consistent with a short cervix or the presence of funneling after the 16-20 weeks gestation (urgent cerclage) and for women who present the asymptomatic dilation of the uterine cervix of at least 2 cm and/or a prolapse of the amniochorial membranes (emergent cerclage). So far there is still a lack of controlled and randomized trials that can unquestionably demonstrate the advantages of the cervical cerclage in comparison with a 'wait and see' aptitude. The cerclage can be performed either transvaginally, usually according to the McDonald technique, or transabdominally. This last approach is recommended when a transvaginal cerclage has to be avoided because of technical difficulties depending on the conditions of the cervix or when the pregnant woman has a history of one or more failed transvaginal cerclages. Interesting perspectives are currently offered by the laparoscopic cerclage, a method that has been effective and unexpectedly safe till now.     

Ultrasonographic diagnosis of cervical incompetence

OBJECTIVE: The aim of this study was to verify clinical diagnosis of cervical incompetence by the use of transvaginal sonography. MATERIAL AND METHODS: 101 pregnant women hospitalized at the Pathological Pregnancy Department, Medical University of Lodz in years 2000-2002 because of suspicion of cervical incompetence were analysed. The mean age of examined group was 24 +/- 3.24 yr. All pregnant women underwent ultrasound cervical assessment at the 18-30 week of gestation by using Hitachi EUB 515C system. Sonographic measurements of cervical length and width were performed. The cervical length below 30 mm and width at least 6 mm were sonographic criteria of cervical incompetence. RESULTS: In 63 pregnant women cervical incompetence was not confirmed by ultrasound examination. In 38 patients sonographic features of cervical incompetence were established. 38 pregnant women were underwent elective cervical cerclage for cervical incompetence. Because of poor previous history 8 women with normal ultrasound examination were treated by cervical cerclage. CONCLUSIONS: We conclude, that clinical diagnosis of cervical incompetence should be verified by the use of transvaginal sonography to provide an objective diagnosis.