G3 with previous second trimester abortion presents at 22 week of gestation with abdominal pain, USG shows tunneling of internal os and cervical length 21 mm. What is the ideal management?
**Core Concept**
In this scenario, the patient presents with symptoms and ultrasound findings consistent with cervical insufficiency, a condition where the cervix begins to dilate prematurely, leading to preterm labor. This is often a complication of previous cervical trauma or surgery, such as a second-trimester abortion.
**Why the Correct Answer is Right**
The management of cervical insufficiency in this case involves the use of a cervical cerclage, a surgical procedure that reinforces the cervix with sutures to prevent further dilation and preterm labor. The American College of Obstetricians and Gynecologists (ACOG) recommends cerclage placement in women with a history of cervical insufficiency or previous preterm birth, and in those with ultrasound evidence of cervical shortening or funneling, such as in this case.
**Why Each Wrong Option is Incorrect**
**Option A:**
This option may be incorrect as it does not address the underlying issue of cervical insufficiency and may not provide adequate support to the cervix.
**Option B:**
This option may be incorrect as it does not take into account the patient's history of previous cervical trauma and the current ultrasound findings of cervical shortening.
**Option C:**
This option may be incorrect as it does not provide a clear management plan for the patient's condition and may not address the risk of preterm labor.
**Clinical Pearl / High-Yield Fact**
It is essential to note that the decision to place a cerclage should be made in consultation with a high-risk obstetrician, and should be based on a combination of the patient's medical history, ultrasound findings, and clinical judgment.
**Correct Answer:** C. Placement of cervical cerclage