The aplication of arabin pessar ia the treatment and prophylactic of incompetent os

Abstract

Isthmocervical insufficiency is one of the most important problems in modern perinatology because in many patients it leads to abortion or premature labor.

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Objective: Recently many surgical procedures like cerclages of different types were introduced into treatment and prophylactic of incompetent os. Arabin pessar seems to be the alternate nonsurgical method. Study design: The aim of our researches is to judge the effects of Arabin pessar insertion in treatment of isthmocervical insufficiency. The method has been applying in our Department since September 1998. The studied material involved 20 patients, mostly multi para, with indications for cordage. Two of patients were carrying twins. Pessars were inserted in the 2^nd trimester of pregnancy and evacuated 2 weeks before estimated term of delivery. Pessars were inserted only if vaginal biocenosis estimated on the base of smear and bacteriological culture were correct. Indications for pessar insertion were judged on the base of interview, internal examination and transvaginal USG were we put special attention to the cervix length and width, length and width of cervix canal and also to the internal os shape and dilatation (tunneling) US G parameters were estimated at rest, at cough trial and during slight pressure on the uterine fundus.

Results: At the present time some of patients from the studied group delivered at term healthy newborns with no signs of infection. The course of pregnancy in other patients seems to be uncomplicated. In I woman we had to evacuate pessar in 33 week of pregnancy due to reoccurring contractions which did not respond to tocolysis.

Conclusion: Arabin pessar insertion seems to be effective method in treatment and prophylactic of isthmocervical insufficiency. The method is relatively less invasive, cheap and can be applied in outpatient clinic. There is no need of hospitalization under condition of frequent medical control with the special attention put on symptoms of vaginal infections.