This chapter reviews the problem of cervical change and cervical insufficiency as related to preterm delivery. Recommendations for surveillance and best practice are made, and the principal surgical procedures for cervical reinforcement (cerclage) are discussed and critiqued. Endovaginal sonography is the best method for the evaluation of women at risk for preterm delivery or cervical insufficiency during pregnancy. Late and uncommon complications of cerclage include fistula formation and, rarely, cervical stenosis. Cicatrix formation can result in cervical dystocia in labor or eventuate in deep cervical lacerations at delivery, which can extend into the broad ligament. Cervical cerclages are best classified based on their timing and the anatomic approach taken for the repair. In terms of timing, these procedures are considered as elective, urgent, or emergent. The current approach to the placement of cerclage is most often transvaginal, and most procedures are performed during pregnancy.

This chapter presents an overview of both maternal and infant birth injuries, considering their etiology, potential methods of avoidance, and critiques of current obstetric practices. The more significant maternal complications of parturition include birth canal lacerations, episiotomy extensions, other perineal or rectal injuries, and various degrees of intrapartum and postpartum hemorrhage. Certain clinical settings predispose to birth injury, including labor stimulation, dystocia/macrosomia, preterm delivery, the diagnosis of acute fetal jeopardy from any cause, and instrumental or cesarean delivery. Superficial maternal birth canal injuries such as soft-tissue abrasions, ecchymoses, or small lacerations are common enough to be considered normal. Vaginal and cervical lacerations, urinary tract dysfunction, uterine infection, uterine rupture are other specific maternal birth injuries discussed in the chapter. The most common direct fetal injury after maternal blunt trauma is a cranial fracture.