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A case of recurrent miscarriage

BMJ 2005; 331 doi: (Published 01 December 2005) Cite this as: BMJ 2005;331:0512449
  1. Marie-Claire Wilson, medical student1,
  2. Nishanthan Rajakumaraswamy, medical student1,
  3. Wai Yoong, consultant obstetrician and gynaecologist1
  1. 1Royal Free and University College Medical School
  2. 2North Middlesex Hospital

A 30 year old woman booked for antenatal care of a much wanted pregnancy at nine weeks' gestation. She had previously undergone three surgical terminations of pregnancy at 15, 12, and 10 weeks. She was otherwise fit and healthy and the pregnancy was progressing normally. A routine ultrasound scan was done at 19 weeks (figure).


  1. What does the ultrasound scan show and what are the implications for the pregnancy?

  2. What are the causes of this condition?

  3. How should this woman be managed? What are the risks?


  1. The scan shows “beaking” or “funnelling” of the internal cervical os, which could be a sign of cervical incompetence. Cervical incompetence can lead to a midtrimester miscarriage.

  2. Cervical surgery, such as cone biopsy (where a small piece of the cervix is removed for testing), forceful dilatation of the cervix (especially in late surgical terminations), trauma during labour, congenital malformations (for example, hypoplastic cervix), and connective tissue disorders (for example, Marfan's syndrome) can all cause cervical …

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