Spontaneous resolution of a midtrimester dilated cervix with expectant management guided by quantitative foetal fibronectin results

History A 38-year-old Caucasian woman at 25  1 weeks’ gestation with a history of three previous spontaneous miscarriages at 6, 7 and 12 weeks’ gestation was admitted to the antenatal ward with complaints of mild abdominal tightening. She had no associated vaginal bleeding or discharge. Her pregnancy had otherwise been uneventful. Upon speculum examination, her cervix was observed to be dilated by 3 cm with bulging foetal membranes. A cervicovaginal fluid (CVF) quantitative foetal fibronectin (qfFN) test was performed which was marginally raised (83 ng/mL). Threatened preterm labour was diagnosed. The patient’s symptoms settled overnight and the case was managed expectantly. Cervical cerclage was not performed in view of the gestation. Two doses of dexamethasone were administered. Her urine dipstick analysis was negative. She was admitted to the antenatal ward where she remained asymptomatic. Twelve days after admission her qfFN test was repeated, and qfFN concentration was very low (4 ng/ml). At this time the cervix was closed, measuring 30–33 mm. She was discharged at 27  3 weeks’ gestation with a plan to be assessed weekly at clinic until delivery. Her qfFN concentration remained low during her weekly follow-up visits, although there was funnelling of the cervix noted with application of suprapubic pressure (Figure 1). A plan was introduced to induce labour at 37 weeks’ gestation, following concerns over foetal heart rate decelerations detected after reduced foetal movements. The patient delivered a 6.4-lb boy with assistance of ventouse, with Apgar scores of 9 at 1 min and 10 at 5 min. The umbilical cord had a true knot. The infant was jaundiced and required ultraviolet therapy. Mother and child were discharged three days after delivery and were both well.