{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,29]],"date-time":"2026-05-29T23:19:32Z","timestamp":1780096772925,"version":"3.54.0"},"reference-count":13,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2026,3,4]],"date-time":"2026-03-04T00:00:00Z","timestamp":1772582400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JPM"],"abstract":"<jats:p>Over the past two decades, the term cervical incompetence has largely been replaced by cervical insufficiency in clinical guidelines, reflecting efforts to avoid pejorative language and to acknowledge functional variability.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\u2013fetal 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\u2013fetal outcomes.<\/jats:p>","DOI":"10.3390\/jpm16030149","type":"journal-article","created":{"date-parts":[[2026,3,4]],"date-time":"2026-03-04T13:11:36Z","timestamp":1772629896000},"page":"149","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Cervical Insufficiency Beyond Terminology: From Fixed Labels to Pregnancy-Specific Vulnerability in Personalized Maternal\u2013Fetal Care"],"prefix":"10.3390","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0009-0006-0890-0259","authenticated-orcid":false,"given":"Moon-Il","family":"Park","sequence":"first","affiliation":[{"name":"Department of Obstetrics and Gynecology, Cervical Insufficiency Center, Dongtan Jeil Women\u2019s Hospital, Hwaseong 18450, Republic of Korea"},{"name":"Department of Obstetrics and Gynecology, Hanyang University Hospital, Seoul 04763, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yong-Jin","family":"Park","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Cervical Insufficiency Center, Dongtan Jeil Women\u2019s Hospital, Hwaseong 18450, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,3,4]]},"reference":[{"key":"ref_1","unstructured":"Society for Maternal-Fetal Medicine (SMFM) (2024). 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Med."},{"key":"ref_5","doi-asserted-by":"crossref","unstructured":"Mitrogiannis, I., Evangelou, E., Efthymiou, A., Kanavos, T., Birbas, E., Makrydimas, G., and Papatheodorou, S. (2023). Risk factors for preterm birth: An umbrella review of meta-analyses of observational studies. BMC Med., 21.","DOI":"10.1186\/s12916-023-03171-4"},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"Amabebe, E., Ikumi, N., Oosthuizen, A., Soma-Pillay, P., Matjila, M., and Anumba, D. (2024). Gestation-dependent increase in cervicovaginal pro-inflammatory cytokines and cervical extracellular matrix proteins is associated with spontaneous preterm delivery within 2 weeks of index assessment. Front. Immunol., 15.","DOI":"10.3389\/fimmu.2024.1377500"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"R11","DOI":"10.1530\/REP-22-0046","article-title":"The immunobiology of preterm labor and birth: Intra-amniotic inflammation or breakdown of maternal-fetal homeostasis","volume":"164","author":"Galaz","year":"2022","journal-title":"Reproduction"},{"key":"ref_8","first-page":"CD007235","article-title":"Cervical assessment by ultrasound for preventing preterm delivery","volume":"9","author":"Berghella","year":"2019","journal-title":"Cochrane Database Syst. Rev."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"317","DOI":"10.1016\/j.siny.2006.05.001","article-title":"Inflammation in preterm and term labour and delivery","volume":"11","author":"Romero","year":"2006","journal-title":"Semin. Fetal Neonatal Med."},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Park, Y.J., and Park, M.I. (2025). Double Versus Single Cervical Cerclage in Women with Cervical Insufficiency: A Systematic Review of Prophylactic and Emergency Indications. Reprod. Biomed., 6.","DOI":"10.3390\/reprodmed6040041"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"75","DOI":"10.1016\/S0140-6736(08)60074-4","article-title":"Epidemiology and causes of preterm birth","volume":"371","author":"Goldenberg","year":"2008","journal-title":"Lancet"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"101756","DOI":"10.1016\/j.ajogmf.2025.101756","article-title":"Cerclage for short cervix \u226420 mm before 24 weeks in singleton gestations without prior spontaneous preterm birth decreases preterm birth: A meta-analysis of randomized controlled trials using individual patient-level data","volume":"7","author":"Berghella","year":"2025","journal-title":"Am. J. Obstet. Gynecol. MFM"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"2275","DOI":"10.1016\/S0140-6736(19)31205-X","article-title":"ICD-11","volume":"393","author":"Lancet","year":"2019","journal-title":"Lancet"}],"container-title":["Journal of Personalized Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-4426\/16\/3\/149\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,4]],"date-time":"2026-03-04T13:36:35Z","timestamp":1772631395000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-4426\/16\/3\/149"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3,4]]},"references-count":13,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2026,3]]}},"alternative-id":["jpm16030149"],"URL":"https:\/\/doi.org\/10.3390\/jpm16030149","relation":{},"ISSN":["2075-4426"],"issn-type":[{"value":"2075-4426","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,3,4]]}}}