Asymptomatic Manual Cervical Changes

Asymptomatic cervical changes prior to 28 weeks are associated with multiple adverse pregnancy outcomes, especially preterm birth. While most women with second trimester cervical shortening will deliver at term, most women with cervical dilation detected on manual exam will deliver preterm. Identifying the individuals at greatest risk for adverse outcome remains a clinical challenge. Understanding how cervical change, gestational age, and obstetric history contribute to modify risk can aid in judicious application of effective treatment options. Placement of a physical exam-indicated cerclage should be considered for all women with a singleton gestation and manually-detected cervical dilation prior to 24 weeks gestation. There is insufficient evidence to recommend bed rest, progesterone, pessary, indomethacin or other therapies for the asymptomatic woman with manually-detected cervical changes in the second trimester.