Comparative analysis of surgical and conservative treatment of pregnant women with cervical incompetence in case of amniotic sac prolapse


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Abstract

Objective. Isthmic-cervical insufficiency (ICI) is the adverse for the prolapsed membrane (PM) is extremely unfavorable in terms of early and very early preterm birth, as well as high levels morbidity. The results of recent studies show that rescue cerclage with the appointed tocolytics and glucocorticoids significantly increases the chances of neonatal survival. At the same time, the enrolment for rescue cerclage at ICI and PM requires a convincing evidence base and further clinical studies. To analyze obstetric and perinatal outcomes in pregnant women with ICI after expectant management and bed rest. Materials and methods. The study included 97 patients with ICI and PM in the gestation period of 19-26 weeks. The first group consisted of 65 pregnant women with active tactics (rescure serclage). The second group of 32 pregnant women underwent conservative management tactics (bed rest). The patients of both groups received traditional courses of antibacterial therapy and prophylaxis of fetal respiratory distress syndrome. Results and discussion: performance of cerclage by the method of Mac-Donald with the active management of patients with ICI and the PM was conducted with the additional manipulation, including the holding of transabdominal amnioreduction under the control of echography, tight filling the bladder and intracervical introduction of the Foley catheter. The use of active tactics facilitated pregnancy prolongation for 8 weeks(in average), while holding conservative tactics - only for1.5 weeks. In the first group of patients, the delivery period averaged 30,75±5,5 weeks, in the second group - 25,7±1,7 weeks (p < 0.05). In 38,5% of cases with active tactics the pregnancy prolonged till term gestation. Conclusion. Active management tactics of pregnant women with ICI and PM have significant advantages in comparison with conservative tactics, prolongs pregnancy for a longer period and reduces the level of perinatal losses.

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About the authors

Vitaly B. Tskhay

Krasnoyarsk State Medical University named after V.F. Voyno-Yasenetsky

Email: tchai@yandex.ru
MD., prof., head of Department of Perinatology, Obstetrics and Gynecology, Medical Faculty

Anna Yu. Dudina

Krasnoyarsk State Medical University named after V.F. Voyno-Yasenetsky

Email: anybar@mail.ru
assistant of Department of Perinatology, Obstetrics and Gynecology, Medical Faculty

Elena E. Kochetova

Krasnoyarsk Regional Clinical Center of Maternity and Childhood

Email: elena.kochetova.64@mail.ru
head of Department of Pregnancy Pathology Unit №1

Tatjana T. Lobanova

Krasnoyarsk Regional Clinical Center of Maternity and Childhood

Email: oufd_pc@pericentr.ru
head of Department of Ultrasound and Functional diagnostics

Svetlana V. Reodko

Krasnoyarsk Regional Clinical Center of Maternity and Childhood

Email: sv_reodko@mail.ru
Obstetrician-gynecologist of Department of Pregnancy Pathology Unit №1

Aleksandra V. Mikhailova

Krasnoyarsk State Medical University named after V.F. Voyno-Yasenetsky

Email: alexandraii928@gmail.com
Doctor-resident of Department of Perinatology, Obstetrics and Gynecology, Medical Faculty

Marina Y. Domracheva

Krasnoyarsk State Medical University named after V.F. Voyno-Yasenetsky

Email: m-domracheva@mail.ru
associate professor of Department of Perinatology, Obstetrics and Gynecology, Medical Faculty

Vyacheslav N. Konovalov

Krasnoyarsk State Medical University named after V.F. Voyno-Yasenetsky

Email: konovalovvn@gmail.com
assistant of Department of Perinatology, Obstetrics and Gynecology, Medical Faculty

Ekaterina Valerievna Bezruk

Krasnoyarsk Regional Clinical Center of Maternity and Childhood

Email: ekbezruk@yandex.ru
obstetrician-gynecologist of Department of Pregnancy Pathology Unit №1

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