Question

A 40 year old G2P1 woman with 18 weeks of amenorrhea comes with a dilated cervix. The cervical length is 15 mm. In spite of explaining the risks, she insisted on cerclage. Which of the following is a contraindication for cervical cerclage? 

• A. Ruptured membranes
• B. Prolapse of membranes into the vagina
• C. Fetal fibronectin positive
• D. Advanced maternal age

Answer 1

The Correct Option is B

In the context of obstetrics and gynecology, a cervical cerclage is a procedure where stitches are used to close the cervix during pregnancy to prevent preterm birth or miscarriage. This procedure is typically considered for women who have a history of cervical insufficiency.

When evaluating a candidate for this procedure, it is crucial to identify any contraindications that would make the procedure unsafe or inappropriate. Listed are the options given:

• Ruptured membranes
• Prolapse of membranes into the vagina
• Fetal fibronectin positive
• Advanced maternal age

Among these, the prolapse of membranes into the vagina is the correct answer, as it is a contraindication for cervical cerclage. This condition signifies that the membranes are bulging through the cervix, increasing the risk of rupture during the procedure.

Other options are considered as follows:

• Ruptured membranes: This is also generally considered a contraindication as it indicates a high risk of infection and other complications.
• Fetal fibronectin positive: While it indicates a higher risk of preterm labor, it is not an absolute contraindication for cervical cerclage but rather a marker to guide clinical decisions.
• Advanced maternal age: Though it may be associated with other pregnancy risks, it is not a contraindication for cervical cerclage.

Therefore, the most direct contraindication for proceeding with a cervical cerclage in this scenario is the prolapse of membranes into the vagina.