Skip to main content
SpringerLink
Log in

Short cervix syndrome: current knowledge from etiology to the control

  • Maternal-Fetal Medicine
  • Published:
Archives of Gynecology and Obstetrics Aims and scope Submit manuscript

Abstract

Background

Preterm delivery is one of the most serious public health problems and is the most important factor relating to neonatal morbidity and mortality. The strategies for preventing it include understanding the risk factors, with specific interventions. Recently, uterine cervix measurements using ultrasonography and vaginal administration of progesterone have gained importance in predicting and secondarily preventing spontaneous preterm delivery.

Objective

To describe the short cervix syndrome, including its etiology, diagnosis, and possible therapies.

Methods

Research in ISI, Pubmed, and Scielo database using the words short cervix, preterm delivery, sludge, cervical funneling, cervical gland area, progesterone, cerclage, and pessary.

Results

We found a lot of articles about this topic, including randomized controlled trials. The etiology is multifactorial, being the diagnosis based in a cervix shortening at 20–24 weeks. The history and measurement of cervix length by transvaginal ultrasound have been shown to be effective to select the high risk pregnancies. The progesterone, cervical cerclage, and cervical pessary showed to be effective to reduce the preterm delivery in pregnant women with short cervix.

Conclusion

The successful management of pregnant women presenting a short cervix depends on the understanding that cervical shortening is the final common path for several causes of preterm delivery. The best approach should be individualized to each patient.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Haram K, Mortensen JH, Wollen AL (2003) Preterm delivery: an overview. Acta Obstet Gynecol Scand 82:687–704

    Article  PubMed  Google Scholar 

  2. Nicolaides KH (2007) Some thoughts on the true value of ultrasound. Ultrasound Obstet Gynecol 30:671–674

    Article  PubMed  Google Scholar 

  3. Sinno A, Usta IM, Nassar AH (2009) A short cervical length in pregnancy: management options. Am J Perinatol 26:761–770

    Article  PubMed  Google Scholar 

  4. Sotiriadis A, Papatheodorou S, Kavvadias A, Makrydimas G (2010) Transvaginal cervical length measurement for prediction of preterm birth in women with threatened preterm labor: a meta-analysis. Ultrasound Obstet Gynecol 35:54–64

    Article  PubMed  CAS  Google Scholar 

  5. Poon LC, Savvas M, Zamblera D, Skyfta E, Nicolaides KH (2012) Large loop excision of transformation zone and cervical length in the prediction of spontaneous preterm delivery. BJOG 119:692–698

    Article  PubMed  CAS  Google Scholar 

  6. Vaisbuch E, Romero R, Erez O, Kusanovic JP, Mazaki-Tovi S, Gotsch F et al (2010) Clinical significance of early (< 20 weeks) vs. late (20–24 weeks) detection of sonographic short cervix in asymptomatic women in the mid-trimester. Ultrasound Obstet Gynecol 36:471–481

    Article  PubMed  CAS  Google Scholar 

  7. Mancuso MS, Szychowski JM, Owen J, Hankins G, Iams JD, Sheffield JS et al. (2010) Cervical funneling: effect on gestational length and ultrasound-indicated cerclage in high-risk women. Am J Obstet Gynecol 203:259.e1–259.e5

    Google Scholar 

  8. Petit E, Abergel A, Dedet B, Subtil D (2012) The role of infection in preterm birth (article in French). J Gynecol Obstet Biol Reprod (Paris) 41:14–25

    Article  CAS  Google Scholar 

  9. To MS, Skentou C, Chan C, Zagaliki A, Nicolaides KH (2001) Cervical assessment at the routine 23-week scan: standardizing techniques. Ultrasound Obstet Gynecol 17:217–219

    Article  PubMed  CAS  Google Scholar 

  10. Campbell S (2011) Universal cervical-length screening and vaginal progesterone prevents early preterm births, reduces neonatal morbidity and is cost saving: doing nothing is no longer an option. Ultrasound Obstet Gynecol 38:1–9

    Article  PubMed  Google Scholar 

  11. Crane JM, Hutchens D (2011) Transvaginal ultrasonographic measurement of cervical length in asymptomatic high-risk women with a short cervical length in the previous pregnancy. Ultrasound Obstet Gynecol 38:38–43

    Article  PubMed  CAS  Google Scholar 

  12. Fonseca EB, Celik E, Parra M, Singh M, Nicolaides KH; Fetal Medicine Foundation Second Trimester Screening Group (2007) Progesterone and the risk of preterm among women with a short cervix. N Engl J Med 357:462–469

    Google Scholar 

  13. Yamasaki AA, Bittar RE, Fonseca ESB, Martinelli S, Sasaki S, Zugaib M (1998) Prevention of preterm birth: use of digital examination and transvaginal ultrasonography (article in Portuguese). Rev Bras Ginecol Obstet 20:350–356

    Article  Google Scholar 

  14. Keelan J, Marvin K, Sato T, Coleman M, McCowan L, Mitchell M (1999) Cytokine abundance in placental tissues: evidence of inflammatory activation in gestational membranes with term and preterm parturition. Am J Obstet Gynecol 181:1530–1536

    Article  PubMed  CAS  Google Scholar 

  15. Kumar D, Fung W, Moore RM, Pandey V, Fox J, Stetzer B et al (2006) Proinflammatory cytokines found in amniotic fluid induce cervical remodeling, apoptosis, and biophysical weakening of cultured human fetal membranes. Biol Reprod 74:29–34

    Article  PubMed  Google Scholar 

  16. Keeler SM, Kiefer DG, Rust OA, Vintzileos A, Atlas RO, Bornstein E et al. (2009) Comprehensive amniotic fluid cytokine profile evaluation in women with a short cervix: which cytokine(s) correlates best with outcome? Am J Obstet Gynecol 201:276.e1–276.e6

    Google Scholar 

  17. Kiefer DG, Keeler SM, Rust O, Chow SS, Craig ME, Peltier MR et al. (2012) Amniotic fluid inflammatory score is associated with pregnancy outcome in patients with mid trimester short cervix. Am J Obstet Gynecol 206:68.e1–68.e6

    Google Scholar 

  18. Peaceman AM, Andrews WW, Thorp JM (1997) Fetal fibronectin as a predictor of preterm birth in patients with symptoms: a multicenter trial. Am J Obstet Gynecol 177:13–18

    Article  PubMed  CAS  Google Scholar 

  19. Yoneda S, Sakai M, Sasaki Y, Shiozaki A, Hidaka T, Saito S (2007) Interleukin-8 and glucose in amniotic fluid, fetal fibronectin in vaginal secretions and preterm labor index based on clinical variables are optimal markers for preterm delivery in patients with intact membranes. J Obstet Gynaecol Res 33:38–44

    Article  PubMed  CAS  Google Scholar 

  20. Honest H, Forbes CA, Durée KH, Norman G, Duffy SB, Tsourapas A et al (2009) Screening to prevent spontaneous preterm birth: systematic reviews of accuracy and effectiveness literature with economic modelling. Health Technol Assess 13:1–627

    PubMed  CAS  Google Scholar 

  21. Cicero S, Skentou C, Souka A, To MS, Nicolaides KH (2001) Cervical length at 22–24 weeks of gestation: comparison of transvaginal and transperineal-translabial ultrasonography. Ultrasound Obstet Gynecol 17:335–340

    Article  PubMed  CAS  Google Scholar 

  22. Andersen HF, Nugent CE, Wanty SD, Hayashi RH (1990) Prediction of risk for preterm delivery by ultrasonographic measurement of cervical length. Am J Obstetr Gynecol 163:859–867

    CAS  Google Scholar 

  23. Hassan SS, Romero R, Vidyadhari D, Fusey S, Baxter JK, Khandelwal M et al (2011) Vaginal progesterone reduces the rate of preterm birth in women with a sonographic short cervix: a multicenter, randomized, double-blind, placebo-controlled trial. Ultrasound Obstet Gynecol 38:18–31

    Article  PubMed  CAS  Google Scholar 

  24. To MS, Skentou CA, Royston P, Yu CK, Nicolaides KH (2006) Prediction of patient-specific risk of early preterm delivery using maternal history and sonographic measurement of cervical length: a population-based prospective study. Ultrasound Obstet Gynecol 27:362–367

    Article  PubMed  CAS  Google Scholar 

  25. O’Brien JM, Defranco EA, Adair CD, Lewis DF, Hall DR, How H et al (2009) Effect of progesterone on cervical shortening in women at risk for preterm birth: secondary analysis from a multinational, randomized, double-blind, placebo-controlled trial. Ultrasound Obstet Gynecol 34:653–659

    Article  PubMed  Google Scholar 

  26. Owen J, Iams JD, Hauth JC (2003) Vaginal sonography and cervical incompetence. Am J Obstet Gynecol 188:586–596

    Article  PubMed  Google Scholar 

  27. Sekiya T, Ishihara K, Yoshimatsu K, Fukami T, Kikuchi S, Araki T (1998) Detection rate of the cervical gland area during pregnancy by transvaginal sonography in the assessment of cervical maturation. Ultrasound Obstet Gynecol 12:328–333

    Article  PubMed  CAS  Google Scholar 

  28. Yoshimatsu K, Sekiya T, Ishihara K, Fukami T, Otabe T, Araki T (2002) Detection of cervical gland area in threatened preterm labor using transvaginal sonography in the assessment of cervical maturation and the outcome of pregnancy. Gynecol Obstet Invest 53:149–156

    Article  PubMed  Google Scholar 

  29. Fukami T, Ishihara K, Sekiya T, Araki T (2003) Is transvaginal ultrasonography at mid-trimester useful for predicting early spontaneous preterm birth? J Nippon Med Sch 70:135–140

    Article  PubMed  Google Scholar 

  30. Pires CR, Moron AF, Mattar RM, Kulay Junior L (2004) Assessment of cervix length and absent of echo-glandular endocervical to predict preterm delivery (article in Portuguese). Rev Bras Ginecol Obstet 26:193–200

    Article  Google Scholar 

  31. Pires CR, Moron AF, Mattar R, Diniz AL, Andrade SG, Bussamra LC (2006) Cervical gland area as an ultrasonographic marker for preterm delivery. Int J Gynaecol Obstet 93:214–219

    Article  PubMed  CAS  Google Scholar 

  32. Espinoza J, Gonçalves LF, Romero R, Nien JK, Stites S, Kim YM et al (2005) The prevalence and clinical significance of amniotic fluid ‘sludge’ in patients with preterm labor and intact membranes. Ultrasound Obstet Gynecol 25:346–352

    Article  PubMed  CAS  Google Scholar 

  33. Kusanovic JP, Espinoza J, Romero R, Gonçalves LF, Nien JK, Soto E et al (2007) Clinical significance of the presence of amniotic fluid “sludge” in asymptomatic patients at high risk for spontaneous preterm delivery. Ultrasound Obstet Gynecol 30:706–714

    Article  PubMed  CAS  Google Scholar 

  34. Himaya E, Rhalmi N, Girard M, Tétu A, Desgagné J, Abdous B et al (2011) Midtrimester intra-amniotic sludge and the risk of spontaneous preterm birth. Am J Perinatol 28:815–820

    Article  PubMed  Google Scholar 

  35. Fox NS, Jean-Pierre C, Predanic M, Chasen ST (2007) Does hospitalization prevent preterm delivery in the patient with a short cervix? Am J Perinatol 24:49–53

    Article  PubMed  Google Scholar 

  36. van Os MA, van der Ven JA, Kleinrouweler CE, Pajkrt E, de Miranda E, van Wassenaer A et al (2011) Preventing preterm birth with progesterone: costs and effects of screening low risk women with a singleton pregnancy for short cervical length, the Triple P study. BMC Pregnancy Childbirth 11:77

    Article  PubMed  Google Scholar 

  37. Romero R, Nicolaides K, Conde-Agudelo A, Tabor A, O’Brien JM, Cetingoz E et al. (2012) Vaginal progesterone in women with an asymptomatic sonographic short cervix in the midtrimester decreases preterm delivery and neonatal morbidity: a systematic review and metaanalysis of individual patient data. Am J Obstet Gynecol 206:124.e1–124.e19

    Google Scholar 

  38. Berghella V, Keeler SM, To MS, Althuisius SM, Rust OA (2010) Effectiveness of cerclage according to severity of cervical length shortening: a meta-analysis. Ultrasound Obstet Gynecol 35:468–473

    Article  PubMed  CAS  Google Scholar 

  39. Berghella V, Rafael TJ, Szychowski JM, Rust OA, Owen J (2011) Cerclage for short cervix on ultrasonography in women with singleton gestations and previous preterm birth: a meta-analysis. Obstet Gynecol 117:663–671

    Article  PubMed  Google Scholar 

  40. Simcox R, Shennan A (2012) Reinforcing cerclage in the prevention of preterm birth in women at high risk: a retrospective case-controlled study. Aust N Z J Obstet Gynaecol 52:224–228

    Article  PubMed  Google Scholar 

  41. Arabin B, Halbesma JR, Vork F, Hubener M, van Eyck J (2003) Is treatment with vaginal pessaries an option in patients with a sonographically detected short cervix? J Perinat Med 31:122–133

    Article  PubMed  Google Scholar 

  42. Sieroszewski P, Jasiński A, Perenc M, Banach R, Oszukowski P (2009) The Arabin pessary for the treatment of threatened mid-trimester miscarriage or premature labour and miscarriage: a case series. J Matern Fetal Neonatal Med 22:469–472

    Article  PubMed  CAS  Google Scholar 

  43. Goya M, Pratcorona L, Merced C, Rodó C, Valle L, Romero A et al (2012) Cervical pessary in pregnant women with a short cervix (PECEP): an open-label randomised controlled trial. Lancet 379:1800–1806

    Article  PubMed  Google Scholar 

  44. Yoshizato T, Inoue Y, Fukami T, Sanui A, Miyamato S, Kawarabayashi T (2010) Longitudinal changes in canal length at 16–35 weeks in normal twin pregnancies and twin pregnancies with preterm labor and delivery. J Obstet Gynaecol Res 4:733–738

    Article  Google Scholar 

  45. Conde-Agudelo A, Romero R (2010) Cervicovaginal fetal fibronectin for the prediction of spontaneous preterm birth in multiple pregnancies: a systematic review and meta-analysis. J Matern Fetal Neonatal Med 23:1365–1376

    Article  PubMed  Google Scholar 

  46. Gibson JL, Macar LM, Owen P, Young D, Macauly J, Mackenzie F (2004) Prediction of preterm delivery in twin pregnancy: a prospective, observational study of cervical length and fetal fibronectin testing. Ultrasound Obstet Gynecol 23:561–566

    Article  PubMed  CAS  Google Scholar 

  47. Fox NS, Saltzman DH, Klauser CK, Peress D, Gutierrez CV, Rebarber A (2009) Prediction of spontaneous preterm birth in asymptomatic twin pregnancies with the use of combined fetal fibronectin and cervical length. Am J Obstet Gynecol 201:313.e1–313.e5

    Google Scholar 

  48. Klein K, Rode L, Nicolaides KH, Krampl-Bettelheim E, Tabor A; PREDICT Group (2011) Vaginal micronized progesterone and risk of preterm delivery in high-risk twin pregnancies: secondary analysis of a placebo-controlled randomized trial and meta-analysis. Ultrasound Obstet Gynecol 38:281–287

  49. Durnwald CP, Momirova V, Peaceman AM (2010) Second trimester cervical length and risk of preterm birth in women with twin gestations treated with 17 alpha hydroxyprogesterone caproate. J Matern Fetal Neonatal Med 23:1360–1364

    Article  PubMed  CAS  Google Scholar 

  50. Rode L, Klein K, Nicolaides KH, Krampl-Bettelheim, Tabor A, for the PREDICT Group (2011) Prevention of preterm delivery in twin gestations (PREDICT): a multicenter, randomized, placebo-controlled trial on the effect of vaginal micronized progesterone. Ultrasound Obstet Gynecol 38:272–280

    Google Scholar 

  51. Brubaker SG, Gyamfi C (2012) Prediction and prevention of spontaneous preterm birth in twin gestations. Semin Perinatol 3:190–194

    Article  Google Scholar 

Download references

Conflict of interest

None.

Author information

Authors and Affiliations

  1. Department of Obstetrics, Federal University of São Paulo (UNIFESP), Rua Carlos Weber, 956, apto. 113 Visage, Vila Leopoldina, São Paulo, CEP 05303-000, SP, Brazil

    Edward Araujo Júnior, Luciano Marcondes Machado Nardozza & Antonio Fernandes Moron

  2. São Paulo Ultrasound Training Center (CETRUS), São Paulo, SP, Brazil

    Claudio Rodrigues Pires

  3. Imaging Training Center (CETRIM), João Pessoa, PB, Brazil

    Hélio Antonio Guimarães Filho

Authors
  1. Hélio Antonio Guimarães Filho
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Edward Araujo Júnior
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Claudio Rodrigues Pires
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Luciano Marcondes Machado Nardozza
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Antonio Fernandes Moron
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Edward Araujo Júnior.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Guimarães Filho, H.A., Araujo Júnior, E., Pires, C.R. et al. Short cervix syndrome: current knowledge from etiology to the control. Arch Gynecol Obstet 287, 621–628 (2013). https://doi.org/10.1007/s00404-013-2740-0

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00404-013-2740-0

Keywords

Search

Navigation