Successful experience with rescue cerclage for critical isthmicocervical insufficiency


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Abstract

Background: Preterm birth (PB) is one of the leading sociomedical problems in obstetrics, despite the ongoing large-scale prevention programs, including those implemented at national and international levels. The prognostic manifestation of spontaneous PB is isthmicocervical insufficiency (ICI) that occurs subclinically in some cases and, when its diagnosis is delayed or its manifestation is late, requires emergency measures that are rescue cerclage (emergency or salvage cerclage). Case report: A pregnant woman with a family obstetric history underwent surgical correction of critical ICI within the borderline period, which in combination with adequately chosen medical therapy and subsequent insertion of an unloading obstetric pessary, as well as carefully monitoring the vaginal microbiota against infections, made it possible to prolong the pregnancy to full term. Conclusion: The timely diagnosis of ICI makes it possible to implement a whole range of preventive measures in a planned manner after the necessary pre-examination; however, a rescue cerclage can be carried out as the only possible salvage measure aimed at prolonging pregnancy and improving perinatal outcomes in a number of cases due to the clinical scenario, with the surgeon’s sufficient experience and the capabilities of an obstetric hospital.

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About the authors

Zulfiya S. Khodzhaeva

Academician V.I. Kulakov National Medical Research Center of Obstetrics, Gynecology and Perinatology Ministry of Health of the Russian Federation

Email: zkhodjaeva@mail.ru
Dr. Med. Sci., Professor, Deputy Director for Research of Obstetrics Institute of the Institution (Department of Obstetrics) 117997, Russia, Moscow, Ac. Oparin str., 4

Ksenia A. Gorina

Academician V.I. Kulakov National Medical Research Center of Obstetrics, Gynecology and Perinatology Ministry of Health of the Russian Federation

Email: k_gorina@oparina4.ru
Junior Researcher the Department of Pregnancy Pathology 117997, Russia, Moscow, Ac. Oparin str., 4

Maria V. Iurova

Academician V.I. Kulakov National Medical Research Center of Obstetrics, Gynecology and Perinatology Ministry of Health of the Russian Federation

Email: m_yurova@oparina4.ru
PhD student of the Department of Obstetrics and Gynecology 117997, Russia, Moscow, Ac. Oparin str., 4

Kamilla T. Muminova

Academician V.I. Kulakov National Medical Research Center of Obstetrics, Gynecology and Perinatology Ministry of Health of the Russian Federation

Email: k_muminova@oparina4.ru
PhD, Junior Researcher the Department of Pregnancy Pathology 117997, Russia, Moscow, Ac. Oparin str., 4

Madina S. Oshkhunova

Academician V.I. Kulakov National Medical Research Center of Obstetrics, Gynecology and Perinatology Ministry of Health of the Russian Federation

Email: m_ashunova@oparina4.ru
PhD student 117997, Russia, Moscow, Ac. Oparin str., 4

Nataly I. Klimenchenko

Academician V.I. Kulakov National Medical Research Center of Obstetrics, Gynecology and Perinatology Ministry of Health of the Russian Federation

Email: n_klimenchenko@oparina4.ru
PhD, Senior Researcher the Department of Pregnancy Pathology 117997, Russia, Moscow, Ac. Oparin str., 4

References

  1. American College of Obstetricians and Gynecologists. ACOG Practice Bulletin No. 142: Cerclage for the management of cervical insufficiency. Obstet. Gynecol. 2014; 123(2, Pt. 1): 372-9. https://dx.doi.org/10.1097/01.AOG.0000443276.68274.cc.
  2. Brown R., Gagnon R., Delisle M.-F.; Maternal Fetal Medicine Committee. Cervical insufficiency and cervical cerclage. J. Obstet. Gynaecol. Can. 2013; 35(12): 1115-27. https://dx.doi.org/10.1016/S1701-2163(15)30764-7.
  3. Kagan K.O., Sonek J. How to measure cervical length. Ultrasound Obstet. Gynecol. 2015; 45(3): 358-62. https://dx.doi.org/10.1002/uog.14742.
  4. Brown R., Gagnon R., Delisle M.-F. No. 373-Cervical insufficiency and cervical cerclage. J. Obstet. Gynaecol. Can. 2019; 41(2): 233-47. https://dx.doi.org/10.1016/j.jogc.2018.08.009.
  5. Thakur M., Mahajan K. Cervical incompetence. StatPearls; 2020.
  6. Olson D.M. The role of prostaglandins in the initiation of parturition. Best Pract. Res. Clin. Obstet. Gynaecol. 2003; 17(5): 717-30. https://dx.doi.org/10.1016/s1521-6934(03)00069-5.
  7. Boyle A.K., Rinaldi S.F., Norman J.E., Stock S.J. Preterm birth: Inflammation, fetal injury and treatment strategies. J. Reprod. Immunol. 2017; 119: 62-6. https://dx.doi.org/10.1016/j.jri.2016.11.008.
  8. Kim M.G., Shim J.Y., Pak J.H., Jung B.K., Won H.S., Lee P.R. et al. Progesterone modulates the expression of interleukin-6 in cultured term human uterine cervical fibroblasts. Am. J. Reprod. Immunol. 2012; 67(5): 369-75. https://dx.doi.org/10.1111/j.1600-0897.2011.01094.x.
  9. Гусейнова Г.Э., Ходжаева З.С. Клинико-анамнестические особенности женщин с преждевременным разрывом плодных оболочек при преждевременных родах. Акушерство и гинекология. 2019; 8: 54-61. https://dx.doi.org/10.18565/aig.2019.8.54-61.
  10. Министерство здравоохранения Российской Федерации. Клинические рекомендации «Нормальная беременность». 2020.
  11. Ходжаева З.С., Припутневич Т.В., Муравьева В.В., Гусейнова Г.Э., Горина К.А. Оценка состава и стабильности микробиоты влагалища у беременных в процессе динамического наблюдения. Акушерство и гинекология. 2019; 7: 30-8. https://dx.doi.org/10.18565/aig.2019.7.30-38.
  12. Basbug A., Dogan O. A comparison of emergency and therapeutic modified Shirodkar cerclage: an analysis of 38 consecutive cases. Turk. J. Obstet. Gynecol. 2019; 16(1): 1-6. https://dx.doi.org/10.4274/tjod.galenos.2018.33410.
  13. Министерство здравоохранения Российской Федерации. Клинические рекомендации «Преждевременные роды», 2021.
  14. Althuisius S.M., Dekker G.A., Hummel P., van Geijn H.P.; Cervical incompetence prevention randomized cerclage trial. Cervical incompetence prevention randomized cerclage trial: emergency cerclage with bed rest versus bed rest alone. Am. J. Obstet. Gynecol. 2003; 189(4): 907-10. https://dx.doi.org/10.1067/s0002-9378(03)00718-x.
  15. O’Brien J.M. Management of cervical insufficiency and bulging fetal membranes. Obstet. Gynecol. 2006; 107(6): 1421-2; author reply 1422. https://dx.doi.org/10.1097/01.AOG.0000220657.00101.a2.
  16. Stupin J.H., David M., Siedentopf J.-P., Dudenhausen J.W. Emergency cerclage versus bed rest for amniotic sac prolapse before 27 gestational weeks. A retrospective, comparative study of 161 women. Eur. J. Obstet. Gynecol. Reprod. Biol. 2008; 139(1): 32-7. https://dx.doi.org/10.1016/j.ejogrb.2007.11.009.
  17. Schorr S.J., Morales W.J. Obstetric management of incompetent cervix and bulging fetal membranes. J. Reprod. Med. 1996; 41(4): 235-8.
  18. Olatunbosun O.A., Al-Nuaim L., Turnell R.W. Emergency cerclage compared with bed rest for advanced cervical dilatation in pregnancy.Int. Surg. 1995; 80(2):170-4.
  19. Тетруашвили Н.К. Привычный выкидыш. Акушерство и гинекология: новости, мнения, обучение. 2017; 4: 70-87. [Tetruashvili N.K. Recurrent abortion. Obstetrics and Gynecology: News, Opinions, Training. 2017; 4:70-87. (in Russian)].
  20. Porter T.F., Scott J.R. Evidence-based care of recurrent miscarriage. Best Pract. Res. Clin. Obstet. Gynaecol. 2005; 19(1): 85-101. https://dx.doi.org/10.1016/j.bpobgyn.2004.11.005.
  21. Kenyon S., Brocklehurst P., Jones D., Marlow N., Salt A., Taylor D. MRC ORACLE Children Study. Long term outcomes following prescription of antibiotics to pregnant women with either spontaneous preterm labour or preterm rupture of the membranes. BMC Pregnancy Childbirth. 2008; 8(1): 14. https://dx.doi.org/10.1186/1471-2393-8-14.

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