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This blog post is based on a Healthful Woman Podcast episode during which Dr. Nathan Fox interviewed fellow board-certified Obstetrician/Gynecologist Dr. Simi Gupta to discuss cervical length screening.

What is Cervical Length?

Cervical length refers to the length of the cervix.  Before pregnancy, the cervix is closed. During the last months of pregnancy, as the body prepares for labor, the cervix usually decreases in length and then opens. If the cervix shortens or dilates before 32 weeks, there is an increased risk of premature labor.

Thankfully, there is a way to measure the length of the cervix to monitor it during pregnancy. “We can measure the length of the cervix on ultrasound, and if we find that it’s shortening earlier in the pregnancy, then we know that those patients are at a higher risk for preterm labor,” Dr. Gupta explained. “And we can talk about different management strategies in that case. This is definitely one of the big things that has come out in predicting preterm birth in the last 10, 20 years or so.” 

About Cervical Length Screening

Most providers will begin measuring the cervical length around 16 weeks, or at the beginning of the second trimester, and stop measuring when they feel the information is less useful to them in high-risk patients.  In low-risk patients, many patients will have their cervical length measured at the time of their anatomy scan around 20 weeks of pregnancy.  Ultimately, how often your provider measures your cervical length will depend on why they are doing it and what they are looking for.

The most accurate way of measuring the length of the cervix is via transvaginal ultrasound. In some cases, an abdominal ultrasound may be performed first. 

“If someone’s at a high risk for a preterm delivery, then we usually say we need to start with a vaginal ultrasound and get the most accurate measurement possible,” Dr. Gupta explained. “For a patient who is low risk for preterm delivery, then we will usually look on an abdominal ultrasound at a routine 20-week or detailed anatomy scan, and only if it looks short will we do a transvaginal ultrasound.” 

Treatments for Short Cervix

For individuals who have a short cervix, there are a variety of treatment options. These may include:

Vaginal Progesterone 

The first available treatment option is vaginal progesterone. This treatment has been found to lower the chance of preterm labor and birth. Women are recommended to use vaginal progesterone every night until they are 37 weeks pregnant. Because this treatment is taken vaginally, there are minimal side effects; however, because progesterone is a hormone, some people may experience mild headaches, nausea, and breast tenderness.

Cervical Cerclage

Cervical cerclage is a solution for keeping the cervix closed during pregnancy to prevent premature birth. This is done by placing a stitch around the opening of the cervix to keep it safely closed during pregnancy. Cervical cerclage is a surgical procedure performed in the hospital under regional anesthesia. 

A cerclage is not recommended for every woman with a short cervix. Rather, it is advised for women who have a prior preterm delivery or some other risk factor for preterm delivery and a short cervix or an extremely short cervix. 

Pessary 

A pessary is a device that fits into the vagina and around the cervix and provides. While they are traditionally placed to treat pelvic organ prolapse, for women with a short cervix, pessaries can be used to try to decrease the risk of preterm delivery.  For pregnant women, the pessary will be taken out when they reach 36-37 weeks of their pregnancy. 

A pessary can be placed during a quick, in-office procedure with minimal associated complications. 

Pregnancy Imaging with Carnegie Imaging for Women

For more information regarding our obstetrical scan services, including cervical length studies, please contact Carnegie Imaging today. Our award-winning team of OB/GYNs and maternal-fetal medicine specialists are dedicated to providing you with professional and compassionate care. 

Carnegie Imaging for Women blogs are intended for educational purposes only and do not replace certified professional care. Medical conditions vary and change frequently. Please ask your doctor any questions you may have regarding your condition to receive a proper diagnosis or risk analysis. Thank you!