Physiologic or Dysfunctional Incompetence of the Cervix

Cervical Insufficiency

“…Later on cases were found without cervical injuries in which the insufficiency was supposed to be due to a congenital weakness of the isthmus or to functional weakness. Several authors therefore recognize three aetiological types of cervical insufficiency (see for example Hunter et al, 1961;Savarese and Chang, 1964).…”

“…The isthmus is permanently widened by earlier mechanical damage such as precipitate labour, forceps or breech extraction before full cervical dilatation, operations such as high amputation, and forceful dilatation before curettage. According to Hunter et al (1961) this group should also include defects of the lower uterine segments [fibroids and other new growths) which distort the isthmus.…”

“…The functional type of cervical insufficiency is obviously very difficult to diagnose in the non-pregnant state. Hunter et al (1961) found that in such cases the internal 0s dilates after vaginal irrigation with bromelain, a proteolytic enzyme mixture prepared from pineapple stems. It is obvious that many of the above described diagnostic procedures have shown that, in retrospective studies, a widened isthmus is often found in the non-pregnant state in cases of cervical insufficiency.…”

“…Shirodkar's original strip of fascia lata has been replaced by threads or strips of different materials: nylon filaments (Hall, 1956;Green-Armytage andBrowne, 1957), silk thread (McDonald, 1957;Bergman, 1958), dacron mesh tubing (Barter et al, 1958), polyethylene tubing with nylon suture (Lewis and Reed, 1959) or silk suture (Rovinsky, 1960), stainless steel wire (Johnstone, 1959;Boyd, 1961), dermal graft (Hunter et al, 1961).…”