# Cervical Insufficiency Beyond Terminology: From Fixed Labels to Pregnancy-Specific Vulnerability in Personalized Maternal–Fetal Care

## TL;DR

This paper argues for rethinking cervical insufficiency as a dynamic pregnancy-specific vulnerability rather than a fixed condition to improve personalized maternal-fetal care.

## Contribution

Proposes a new conceptual model of cervical insufficiency as a dynamic, context-sensitive vulnerability rather than a fixed anatomical defect.

## Key findings

- Static, anatomy-centered models fail to explain clinical heterogeneity in cervical insufficiency.
- Cervical behavior is shaped by mechanical load, biological processes, and gestational timing.
- The new framework supports personalized risk assessment and trajectory-informed clinical decisions.

## Abstract

Over the past two decades, the term cervical incompetence has largely been replaced by cervical insufficiency in clinical guidelines, reflecting efforts to avoid pejorative language and to acknowledge functional variability. However, despite this terminological evolution, the underlying conceptual framework has remained largely static, continuing to treat cervical insufficiency as a fixed anatomic defect inferred from obstetric history or single-point measurements. This Perspective argues that such a model inadequately explains the substantial clinical heterogeneity observed across and within pregnancies, limiting its usefulness for individualized clinical interpretation and study design. Drawing on contemporary guideline frameworks, systematic reviews, and international disease classification systems, this article highlights the limitations of static, anatomy-centered approaches and proposes an alternative conceptualization of cervical insufficiency as a dynamic, pregnancy-specific vulnerability. Within this framework, cervical behavior is understood as time-dependent and context-sensitive, shaped by the interplay of mechanical load, biological processes, and gestational timing rather than predetermined structural failure. This conceptualization is intended to inform interpretation across diverse clinical contexts, rather than to redefine diagnostic criteria or existing guideline recommendations. By shifting emphasis from fixed diagnostic labels to trajectories of cervical vulnerability, this Perspective situates cervical insufficiency within the broader continuum of spontaneous preterm birth and aligns its interpretation with the principles of personalized medicine. This conceptual reframing positions cervical insufficiency as a model condition for personalized maternal–fetal care, emphasizing time- and context-aware risk assessment and trajectory-informed clinical decision-making, while providing a coherent foundation for individualized surveillance and future research aimed at improving maternal–fetal outcomes.