The course and outcomes of pregnancy after surgical correction of uterine cervical incompetence. Risk rating

BACKGROUND: Uterine cervical incompetence is a leading cause of miscarriage. There are surgical and conservative methods of treatment to correct cervical insufficiency during pregnancy. Surgical methods of correction include suture on the cervix (cervical cerclage), which could be categorized as preventive, therapeutic or emergency suture.

AIM: The aim of this study was to compare the clinical effects of preventive and therapeutic cerclages on the course and outcomes of pregnancy in women with uterine cervical incompetence.

MATERIALS AND METHODS: This prospective study included 106 pregnant women aged 20-45 years, who were diagnosed with uterine cervical incompetence and underwent surgical correction at gestation period of 14 to 24 weeks in combination with intravaginal micronized progesterone. The women were divided into two groups. Group 1 (n = 30) included patients without structural abnormalities of the cervix, who underwent prophylactic cerclage. Group 2 (n = 76) consisted of pregnant women who underwent therapeutic cerclage. Examination of the hormonal status included study of anamnesis related to the menstrual and reproductive function and determination of the presence and type of obesity and the severity of secondary sexual characteristics. The anatomical causes of miscarriage were assessed while examining the cervix in the mirrors and using ultrasonography. Dynamic transvaginal ultrasonography was also performed. The markers of the inflammatory response were assessed (complete blood count parameters and C-reactive protein level). In addition, the biochemical blood test and the coagulogram were performed, with a smear study carried out for microbiocenosis and sowing from the cervical canal. The pH balance of the vagina was also determined.

RESULTS: The ratio of patients without structural changes of the cervix with prophylactic cerclage and pregnant women with therapeutic cerclage is 28% and 72%. This means that only 28% of patients with uterine cervical incompetence come to the specialized hospital with medical examination and pregraving preparation. The remaining 72% of women came with the first examination and already had complications of pregnancy.

CONCLUSIONS: Surgical correction is an effective prevention method of late pregnancy loss. Preventive cerclage has advantages – time of manipulation, the number of complications and the stay of pregnant in the hospital are reduced. The use of surgical correction of uterine cervical incompetence has prolonged the pregnancy of all women before the birth of a viable child. This is a good reserve to reduce perinatal morbidity and mortality. The problem of early diagnostics and surgical correction of uterine cervical incompetence remains relevant.