Early therapy for the incompetent cervix in patients with habitual abortion

From a thorough evaluation of 66 couples with habitual abortion (HA), 42 were found to have a widened uterine isthmus at hysterosalpingography (HSG) as their only abnormality. First trimester cervical effacement occurred in 90% of these patients. A combination of medical (progesterone [P]), and surgical (McDonald cerclage) begun during the first trimester resulted in successful term pregnancy in 35 of the 36 HA patients (97%) who were treated. The results of this study suggest that (1) functional cervical incompetence may play a major role in HA; (2) a widened uterine isthmus at HSG and first trimester cervical effacement are clinical signs that may define this group of HA; (3) early recognition and therapy for the incompetent cervix can interrupt the progression of events leading to the loss of an otherwise normally developing fetus; and (4) increased perinatal morbidity demands continuous antepartum assessment of fetoplacental integrity in these patients.