A 37-year-old woman, G3P0, presents to the obstetrics clinic at 14 weeks of gestation for routine follow-up. She has a history of two second-trimester pregnancy losses at 18 and 20 weeks. No previous infections or labor complications were reported. However, her second pregnancy is complicated by gestational diabetes. She had a loop electrosurgical excision procedure done when she was 30 years old. The patient denies any cramping, vaginal bleeding, or fluid leakage. Today her vital signs are: temperature is 99 °F (37.2 °C), heart rate is 108 beats/min, blood pressure is 177/105 mm Hg, respirations are 19 breaths/min, oxygen saturation is 94% on room air, and BMI is 32. Which of the following is a common risk factor for cervical incompetence?
