Protocolo institucional: insuficiência istmocervical e colo curto

Abstract

Cervical insufficiency and short cervix are clinically significant conditions in obstetrics, strongly associated with late pregnancy loss and an increased risk of preterm birth, with substantial impact on neonatal morbidity and mortality. The clinical heterogeneity of these conditions and the partial overlap between their diagnostic criteria pose challenges to standardized management and often result in inconsistent clinical practices. In this context, the present study aimed to develop an institutional clinical protocol for the management of cervical insufficiency and short cervix in singleton pregnancies, based on the best available scientific evidence. This work consists of an evidence-based clinical protocol developed through a critical appraisal of international and national clinical guidelines, selected according to methodological rigor assessed using the AGREE II instrument. The Royal College of Obstetricians and Gynaecologists, the Society of Obstetricians and Gynaecologists of Canada, and the American College of Obstetricians and Gynecologists guidelines were adopted as primary references, complemented by recommendations from the International Federation of Gynecology and Obstetrics, the International Society of Ultrasound in Obstetrics and Gynecology, and national flowcharts from the Brazilian Federation of Gynecology and Obstetrics Associations. The protocol establishes clear clinical and ultrasonographic inclusion and exclusion criteria, defines diagnostic parameters based on obstetric history, physical examination, and transvaginal ultrasound measurement of cervical length, and proposes individualized therapeutic strategies, including vaginal progesterone and cervical cerclage according to different clinical scenarios. In addition, structured care pathways, criteria for therapeutic modification, monitoring parameters, and criteria for discharge or referral are presented to ensure safe and consistent implementation in the institutional setting. It is concluded that the standardization of care for cervical insufficiency and short cervix through an evidence-based clinical protocol contributes to uniform clinical decision-making, reduces unnecessary interventions, and enhances maternal–fetal safety, thereby improving the overall quality of obstetric care