The choice of techniques for correction of isthmic-cervical insufficience: the results of the retrospective study


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Abstract

Aim. Assessment of the effectiveness of different methods for correction of isthmic-cervical insufficiency (ICI) and pregnancy outcomes in patients with preterm birth (PB) in history and without PB. Materials and methods. Retrospective analysis included 108 women with ICI, who underwent treatment with cervical cerclage and obstetric pessary. The patients were divided into 2 groups. Group I included 74 (66.7%) women with ICI, who had no PB in history: cervical cerclage was used in 35(47.3%) women and obstetric pessary was used in 39 (52.7%) women. Group II included 34 (33.3%) women with ICI an PB and/or spontaneous late-term miscarriage in history: cervical cerclage was used in 24 (70.6%) patients and obstetric pessary was used in 10 (29.4%) patients. Results. The analysis results did not show significant differences between the two techniques for correction of ICI both in the group of patients with PB and with no PB in history. The assessment of gestational age for correction of ICI showed statistically signif icant differences in both groups: in the group of patients with PB in history, the median gestational age at cervical cerclage was 19 (17-20) weeks, and at pessary placement it was 24.5 (20-26) weeks, (p=0.015). In the group of patients with no PB in history - it was 21 (20-22) and 24 (22-26) weeks, respectively (p<0.001). Overall preterm birth rate in the group of women with no PB in history, who underwent cervical cerclage was 31.42%, and 38.46% among those who underwent obstetric pessary insertion. Term births were in 60% and 53.85% of women, respectively. Preterm birth rate in the group of patients with PB in history who underwent cervical cerclage was 45.84%, and 20% among those who underwent pessary insertion; term births were in 45.83% and 70% of women, respectively. Conclusion. In addition to prolonged support with progesterone and elimination of factors contributing to the occurrence of infection, the techniques for correction of ICI - pessary and cerclage showed similar results with regard to pregnancy prolongation, PB rates and perinatal outcomes both in the group of pregnant women with no PB and in the group of women with PB in history.

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About the authors

Elena V. Timokhina

I.M. Sechenov First Moscow State Medical University, Ministry of Health of Russia (Sechenov University)

Email: elena.timokhina@mail.ru
Dr. Med. Sci., Professor of the Department of Obstetrics, Gynecology and Perinatology of Obstetrics, Gynecology and Perinatology of the Institute of Clinical Medicine Moscow, Russia

Alexander N. Strizhakov

I.M. Sechenov First Moscow State Medical University, Ministry of Health of Russia (Sechenov University)

Email: kafedra-agp@mail.ru
Academician of the Russian Academy of Sciences, Professor, Head of the Department of Obstetrics, Gynecology and Perinatology of the of the Institute of Clinical Medicine Moscow, Russia

Svetlana V. Pesegova

I.M. Sechenov First Moscow State Medical University, Ministry of Health of Russia (Sechenov University)

Email: svpesegova@gmail.com
Post-Graduate Student, Department of Obstetrics, Gynecology and Perinatology of the Institute of Clinical Medicine Moscow, Russia

Vera S. Belousova

I.M. Sechenov First Moscow State Medical University, Ministry of Health of Russia (Sechenov University)

PhD, Associate Professor of the Department of Obstetrics, Gynecology and Perinatology of the Institute of Clinical Medicine Moscow, Russia

Yulia A. Samoilova

S.S. Yudin City Clinical Hospital of Moscow Department of Healthcare

PhD, Head of the 1st Obstetric Department of Pregnancy Pathology Moscow, Russia

References

  1. Sundtoft I., Langhoff-Roos J., Sandager P., Sommer S., Uldbjerg N. Cervical collagen is reduced in non-pregnant women with a history of cervical insufficiency and a short cervix. Acta Obstet. Gynecol. Scand. 2017; 96(8): 98490. https://dx.doi.org/10.1111/aogs.13143.
  2. Белоусова В.С., Стрижаков А.Н., Свитич О.А., Тимохина Е.В., Кукина П.И., Богомазова И.М., Пицхелаури Е.Г. Преждевременные роды: причины, патогенез, тактика. Акушерство и гинекология. 2020; 2: 82-7.
  3. Курцер М.А., Азиев О.В., Панин А.В., Егикян Н.М., Болдина Е.Б., Грабовская А.А. Лапароскопический серкляж при истмико-цервикальной недостаточности, вызванной ранее перенесенными операциями на шейке матки. Акушерство и гинекология. 2017; 5: 58-62
  4. Tribe R.M. A translational approach to studying preterm labour. BMC Pregnancy Childbirth. 2007; 7(Suppl. 1): S8. https://dx.doi.org/10.1186/1471-2393-7-S1-S8.
  5. Thain S., Yeo G.S.H., Kwek K., Chern B., Tan K.H. Spontaneous preterm birth and cervical length in a pregnant Asian population. PLoS One. 2020; 15(4): e0230125. https://dx.doi.org/10.1371/journal.pone.0230125.
  6. Wang S.W., Ma L.L., Huang S., Liang L., Zhang J.R. Role of cervical cerclage and vaginal progesterone in the treatment of cervical incompetence with/ without preterm birth history. Chin. Med. J. (Engl). 2016; 129(22): 2670-5. https://dx.doi.org/10.4103/0366-6999.193451.
  7. Romero R., Yeo L., Chaemsaithong P., Chaiworapongsa T., Hassan S.S. Progesterone to prevent spontaneous preterm birth. Semin. Fetal Neonatal Med. 2014; 19(1): 15-26. https://dx.doi.org/10.1016/j.siny.2013.10.004.
  8. Goldenberg R.L., Culhane J.F., Iams J.D., Romero R. Epidemiology and causes of preterm birth. Lancet. 2008; 371(9606): 75-84. https://dx.doi.org/10.1016/S0140-6736(08)60074-4.
  9. Park S., You Y.A., Yun H., Choi S.J., Hwang H.S., Choi S.K. et al. Cervicovaginal fluid cytokines as predictive markers of preterm birth in symptomatic women. Obstet. Gynecol. Sci. 2020; 63(4): 455-63. https://dx.doi.org/10.5468/ogs.19131.
  10. Kim S., Park H.S., Kwon H., Seol H.J., Bae J.G., Ahn K.H. et al.; Korean Society of Ultrasound in Obstetrics and Gynecology Research Group. Effect of cervical cerclage on the risk of recurrent preterm birth after a twin spontaneous preterm birth. J. Korean Med. Sci. 2020; 35(11): e66. https://dx.doi.org/10.3346/jkms.2020.35.e66.
  11. Цхай В.Б., Дудина А.Ю., Кочетова Е.А., Лобанова Т.Т., Реодько С.В., Михайлова А.В.,Домрачева М.Я., Коновалов В.Н., Безрук Е.В. Сравнительный анализ эффективности хирургической и консервативной тактики у беременных с истмико-цервикальной недостаточностью при пролабировании плодного пузыря. Акушерство и гинекология. 2019; 6: 63-9.
  12. Monsanto S.P., Daher S., Ono E., Pendeloski K.P.T., Traina E., Mattar R., Tayade C. Cervical cerclage placement decreases local levels of proinflammatory cytokines in patients with cervical insufficiency. Am. J. Obstet. Gynecol. 2017; 217(4): 455. e1-455. e8. https://dx.doi.Org/10.1016/j.ajog.2017.06.024.
  13. Yoo H.N., Park K.H., Jung E.Y., Kim Y.M., Kook S.Y., Jeon S.J. Non-invasive prediction of preterm birth in women with cervical insufficiency or an asymptomatic short cervix (<25 mm) by measurement of biomarkers in the cervicovaginal fluid. PLoS One. 2017; 12(7): e0180878. https://dx.doi.org/10.1371/journal.pone.0180878.
  14. Любимова А.И., Мамедалиева Н.М. Способ лечения истмико-цервикальной недостаточности. Патент 902733. Заявлено 19.06.1980. Опубликовано 07.02.1982. Бюллетень №5. Федеральный институт промышленной собственности, отделение ВПТБ. Описание изобретения к авторскому свидетельству
  15. Леваков С.А., Боровкова Е.И., Шешукова Н.А., Боровков И.М. Ведение пациенток с истмико-цервикальной недостаточностью. Акушерство, гинекология и репродукция. 2016; 10(2): 64-9
  16. Antczak-Judycka A, Sawicki W., Spiewankiewicz B., Cendrowski K., Stelmachow J. Comparison of cerclage and cerclage pessary in the treatment of pregnant women with incompetent cervix and threatened preterm delivery. Ginekol. Pol. 2003; 74(10): 1029-36.
  17. Jung D.U., Choi M.J., Jung S.Y., Kim S.Y. Cervical pessary for preterm twin pregnancy in women with a short cervix. Obstet. Gynecol. Sci. 2020; 63(3): 231-8. https://dx.doi.org/10.5468/ogs.2020.63.3.231.
  18. Saccone G., Ciardulli A., Xodo S., Dugoff L., Ludmir J., Pagani G. et al. Cervical pessary for preventing preterm birth in singleton pregnancies with short cervical length: a systematic review and meta-analysis. J. Ultrasound Med. 2017; 36(8): 1535-43. https://dx.doi.org/10.7863/ultra.16.08054.
  19. Saccone G., Ciardulli A., Xodo S., Dugoff L., Ludmir J., D'Antonio F. et al. Cervical pessary for preventing preterm birth in twin pregnancies with short cervical length: a systematic review and meta-analysis. J. Matern. Fetal Neonatal Med. 2017; 30(24): 2918-25. https://dx.doi.org/10.1080/14767058.2016.1268595.
  20. Alfirevic Z., Owen J., Carreras Moratonas E., Sharp A.N., Szychowski J.M., Goya M. Vaginal progesterone, cerclage or cervical pessary for preventing preterm birth in asymptomatic singleton pregnant women with a history of preterm birth and a sonographic short cervix. Ultrasound Obstet. Gynecol. 2013; 41(2): 146-51. https://dx.doi.org/10.1002/uog.12300.

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