A 33 year old pregnant woman G3P2L0 presents at 9 weeks gestational age . She has a history of conization for CIN one year back & currently is on follow up. She also has the history of preterm bihs at 30 and 32 weeks during her last 2 pregnancies. What is the best step in the management of this patient?
Management consists of doing a cerclage around 12-14 weeks. A 'post conization' cervix & previous preterm bihs are more than sufficient indications for this. Doing the cervical length assessment is pa of the work up here than the definitive management. Tocolysis or bed rest alone will not prevent an Aboion / Preterm labour in a previously challenged cervix.
USG to see cervical length & decide next management
Apply Cervical Cerclage by 12 weeks
Complete bed rest till bility is achieved
Provide low dose Tocolysis with salbutamol till bility
Preterm Labour