L'incompetenza cervicale quale fattore di rischio di parto pretermine: ruolo del cerchiaggio cervicale nell'attuale pratica ostetrica.

Preterm delivery is still the leading cause of neonatal mortality and morbidity. Among the risk factors of preterm delivery, there is also the so called cervical incompetence, that is the inhability of the uterine cervix to support a pregnancy to term, because of a structural or functional defect, either congenital or acquired. The diagnosis of cervical incompetence is mainly made during pregnancy and it is based on the ultrasonographic finding of uterine cervix morphometric changes (shortening and/or funneling, that is funnel-shaped dilatation of the upper portion of the cervical canal). In the light of the current scientific evidences, pregnant women who are at risk for second trimester abortion and/or early preterm delivery should undergo serial trans-vaginal ultrasound examination of the uterine cervix, starting from 16 - 20 week of gestation. In presence of significant cervical morphometric changes, the cerclage should be recommended when: 1) the gestational age is less than 24 weeks; 2) the woman history shows a high a priori risk of preterm delivery; 3) the residual cervical length is less than 20 mm; 4) fetal abnormalities, lower genital tract infections and uterine contractions have been previously ruled out. Up to date, it has not been carried out any clinical trial that demonstrates the efficacy and/or safety of emergency cerclage, performed in response to advanced cervical dilatation. For selected cases (previous failed trans-vaginal cerclage), it is possible to perform trans-abdominal cerclage. In particular, laparoscopic cerclage seems to be an unexpectedly effective and safe treatment. Key words: cervical cerclage, cervical incompetence; cervical insufficiency