CERVICAL INSUFFICIENCY

A   32-year-old primigravida    at  18  weeks’  gestation   comes   to  the maternity

unit    complaining of  pelvic  pressure    and increasing  vaginal mucus

discharge.  She denies  any uterine contractions.   On  pelvic  examination the

fetal   membranes   are seen    bulging into    the vagina, and no  cervix  can be

palpated.   Fetal   feet    can be  felt    through the membranes.  Two years   ago she

underwent   a   cervical    conization  for cervical    intraepithelial neoplasia.