What is the most likely cause of recurrent pregnancy losses in a healthy 34-year-old female with a history of three second trimester miscarriages?

Cervical incompetence is a common cause of recurrent pregnancy losses, especially in the second trimester. This condition occurs when the cervix is unable to support the weight of the growing pregnancy, leading to premature effacement and dilation without painful contractions. In a healthy 34-year-old female who has experienced three second trimester miscarriages, this diagnosis is particularly plausible because the losses occurred relatively late in the first trimester or during the second trimester, which aligns with the timing often seen in cases of cervical incompetence.

Cervical incompetence can be congenital or acquired and might not be obvious until a woman experiences her first pregnancy loss in the second trimester. Diagnosis often involves a history of painless cervical dilation, and it can be confirmed through clinical examination or the use of ultrasound to measure cervical length in subsequent pregnancies. Treatment typically involves cervical cerclage, a procedure to stitch the cervix closed to help prevent further miscarriages.

In contrast, maternal or paternal balanced translocations typically would lead to first trimester losses due to chromosomal abnormalities affecting the embryo’s viability. A retroverted uterus, while it might complicate certain pregnancies, usually does not lead to miscarriages, especially recurrent losses, and often resolves on its own as the uterus expands. Therefore, cervical incompet