Insuficiência Cervical às 20 Semanas: Reconhecimento e Manejo Urgente

Insuficiência cervical (cervo incompetente) é dilatação cervical indolor <24 semanas sem contrações, levando a parto prematuro.

Apresentação às 20 Semanas

• Pressão pélvica, alteração do corrimento vaginal, spotting.
• Often asymptomatic; found on routine transvaginal ultrasound (cervical length <25 mm).

Immediate Actions

1. Contact OB/GYN or go to L&D immediately.
2. Do not delay—each day of prolongation improves neonatal outcomes.

Interventions

• Cerclage (McDonald/Shirodkar): Suture placement to reinforce cervix. Indicated if history of 2nd-trimester loss + short cervix, or singleton with prior spontaneous preterm birth + CL <25 mm <24 wks.
• Vaginal progesterone: 200 mg nightly if CL <25 mm without prior loss (alternative to cerclage).
• Arabin pessary: Silicone device; evidence evolving.
• Activity modification: Avoid heavy lifting, prolonged standing; pelvic rest.
• Corticosteroids: Betamethasone 12 mg IM q24h ×2 if 23–33+6 weeks for fetal lung maturity.
• Antibiotics: If infection suspected (chorioamnionitis).

Prognosis

Cerclage reduces preterm birth <34 weeks by ~30%. Close surveillance (serial CL, fibronectin) essential.