Assessment of the risk of spontaneous preterm birth in pregnant women with the Dr. Arabin cervical pessary

Abstract

BACKGROUND: Preterm birth has a multifactorial etiology, including both maternal and fetal complications, amid the effect of functionally impaired variants of multiple genes. Preterm birth is therefore considered as the “major obstetric syndrome.” One of the anatomical components of this syndrome is a short cervix, and a cervical pessary is used as a prevention of preterm birth in these patients.

AIM: The aim of this study was to identify risk factors for spontaneous preterm birth in pregnant women who received a cervical pessary.

MATERIALS AND METHODS: This prospective, open, randomized cohort study included 189 women with a singleton pregnancy and a short cervix (<25‰ according to the Salomon scale) and a threatened miscarriage / preterm birth in the second and third trimesters trimester, who received the Dr. Arabin cervical pessary. We analyzed 183 parameters and identified the main risk factors leading to spontaneous preterm birth based on pregnancy outcomes.

RESULTS: Based on the pregnancy outcomes, all patients were categorized into two main groups: group I included 167 women with term birth and group II consisted of 19 pregnant women with spontaneous preterm birth. The main risk factors for spontaneous preterm birth in singleton pregnancies in descending order were: the Bishop score ≥7 points (p = 0.00032, OR 12.38, 95 % CI [3.50–43.87]), the modified Steinberg score ≥8 points (p = 0.00056, OR 10.55, 95% CI [3.09–36.03]), cervical length ≤15 mm by transvaginal cervicometry (p < 0.001, OR 7.94, 95% CI [2.83–22.26]), history of preterm birth (p = 0.00128, OR 6.91, 95% CI [2.32–20.56]), chronic placental insufficiency (p = 0.00307, OR 5.06, 95 % CI [1.82–14.01]), genital anomalies (p = 0.07452, OR 5.03, 95% CI [1.15–22.06]), and history of surgical manipulations on the cervix (p = 0.07003, OR 2.90, 95% CI [1.05–8.00]). In multivariate analysis, the risk of spontaneous preterm birth was five times higher in pregnant women with the concomitant presence of three risk factors: cervical length ≤15 mm, the modified Steinberg score ≥8 points, and the Bishop score ≥7 points (83.33% of spontaneous preterm birth compared to 16.67% of term birth; p < 0.05, OR 59.29, 95% CI [6.47–543.29]).

CONCLUSIONS: Among patients with a short cervix and the Dr. Arabin cervical pessary, we have identified groups at higher risk for spontaneous preterm birth.

Keywords

spontaneous preterm birth / risk factors / short cervix / Dr. Arabin cervical pessary / cervical insufficiency

References

[1] FIGO Working Group on Good Clinical Practice in Maternal-Fetal Medicine. Good clinical practice advice: Prediction of preterm labor and preterm premature rupture of membranes. Int J Gynaecol Obstet. 2019;144(3):340–346. DOI: 10.1002/ijgo.12744

[2] FIGO Working Group on Good Clinical Practice in Maternal-Fetal Medicine. Good clinical practice advice: Prediction of preterm labor and preterm premature rupture of membranes // Int. J. Gynaecol. Obstet. 2019. Vol. 144. No. 3. P. 340–346. DOI: 10.1002/ijgo.12744

[3] Figo Working Group On Best Practice In Maternal-Fetal Medicine; International Federation of Gynecology and Obstetrics. Best practice in maternal-fetal medicine. Int J Gynaecol Obstet. 2015;128(1):80–82. [Published correction appears in Int J Gynaecol Obstet. 2015;129(1):89]. DOI: 10.1016/j.ijgo.2014.10.011

[4] FIGO Working Group On Best Practice In Maternal-Fetal Medicine; International Federation of Gynecology and Obstetrics. Best practice in maternal-fetal medicine // Int. J. Gynaecol. Obstet. 2015. Vol. 128. No. 1. P. 80–82. DOI: 10.1016/j.ijgo.2014.10.011

[5] Di Renzo GC, Cabero Roura L, Facchinetti F, et al. Preterm labor and birth management: Recommendations from the European Association of Perinatal Medicine. J Matern Fetal Neonatal Med. 2017;30(17):2011–2030. DOI: 10.1080/14767058.2017.1323860

[6] Di Renzo G.C., Cabero Roura L., Facchinetti F. et al. Preterm labor and birth management: Recommendations from the European Association of Perinatal Medicine // J. Matern. Fetal. Neonatal. Med. 2017. Vol. 30. No. 17. P. 2011–2030. DOI: 10.1080/14767058.2017.1323860

[7] Honest H, Bachmann LM, Sundaram R, et al. The accuracy of risk scores in predicting preterm birth – a systematic review. J Obstet Gynaecol. 2004;24(4):343–359. DOI: 10.1080/01443610410001685439

[8] Honest H., Bachmann L.M., Sundaram R. et al. The accuracy of risk scores in predicting preterm birth – a systematic review // J. Obstet. Gynaecol. 2004. Vol. 24. No. 4. P. 343–359. DOI:10.1080/01443610410001685439

[9] Society for Maternal Fetal Medicine Publications Committee. ACOG Committee Opinion number 419 October 2008 (replaces No. 291, November 2003). Use of progesterone to reduce preterm birth. Obstet Gynecol. 2008;112(4):963–965. DOI: 10.1097/AOG.0b013e31818b1ff6

[10] Society for Maternal Fetal Medicine Publications Committee. ACOG Committee Opinion number 419 October 2008 (replaces No. 291, November 2003). Use of progesterone to reduce preterm birth // Obstet. Gynecol. 2008. Vol. 112. No. 4. P. 963–965. DOI: 10.1097/AOG.0b013e31818b1ff6

[11] Committee on Practice Bulletins – Obstetrics, The American College of Obstetricians and Gynecologists. Practice bulletin No. 130: prediction and prevention of preterm birth. Obstet Gynecol. 2012;120(4):964–973. DOI: 10.1097/AOG.0b013e3182723b1b

[12] Committee on Practice Bulletins – Obstetrics, The American College of Obstetricians and Gynecologists. Practice bulletin No. 130: prediction and prevention of preterm birth // Obstet. Gynecol. 2012. Vol. 120. No. 4. P. 964–973. DOI: 10.1097/AOG.0b013e3182723b1b

[13] Society for Maternal-Fetal Medicine Publications Committee, with assistance of Vincenzo Berghella. Progesterone and preterm birth prevention: translating clinical trials data into clinical practice. Am J Obstet Gynecol. 2012;206(5):376–386. DOI: 10.1016/j.ajog.2012.03.010

[14] Society for Maternal-Fetal Medicine Publications Committee, with assistance of Vincenzo Berghella. Progesterone and preterm birth prevention: translating clinical trials data into clinical practice // Am. J. Obstet. Gynecol. 2012. Vol. 206. No. 5. P. 376–386. DOI: 10.1016/j.ajog.2012.03.010

[15] Romero R, Espinoza J, Kusanovic JP, et al. The preterm parturition syndrome. BJOG. 2006;113(Suppl 3):17–42. DOI: 10.1111/j.1471-0528.2006.01120.x

[16] Romero R., Espinoza J., Kusanovic J.P. et al. The preterm parturition syndrome // BJOG. 2006. Vol. 113. No. 3. Suppl. P. 17–42. DOI: 10.1111/j.1471-0528.2006.01120.x

[17] Requejo J, Merialdi M, Althabe F, et al. Born too soon: care during pregnancy and childbirth to reduce preterm deliveries and improve health outcomes of the preterm baby. Reprod Health. 2013;10 Suppl 1(Suppl 1):S4. DOI: 10.1186/1742-4755-10-S1-S4

[18] Requejo J., Merialdi M., Althabe F. et al. Born too soon: care during pregnancy and childbirth to reduce preterm deliveries and improve health outcomes of the preterm baby // Reprod. Health. 2013. Vol. 10. Suppl. 1. P. S4. DOI: 10.1186/1742-4755-10-S1-S4

[19] Dodd JM, Jones L, Flenady V, et al. Prenatal administration of progesterone for preventing preterm birth in women considered to be at risk of preterm birth. Cochrane Database Syst Rev. 2013;(7):CD004947. DOI: 10.1002/14651858.CD004947.pub3

[20] Dodd J.M., Jones L., Flenady V. et al. Prenatal administration of progesterone for preventing preterm birth in women considered to be at risk of preterm birth // Cochrane Database Syst. Rev. 2013. No. 7. P. CD004947. DOI: 10.1002/14651858.CD004947.pub3

[21] Goya M, Pratcorona L, Merced C, et al. Cervical pessary in pregnant women with a short cervix (PECEP): an open-label randomised controlled trial. Lancet. 2012;379(9828):1800–1806. DOI: 10.1016/S0140-6736(12)60030-0

[22] Goya M., Pratcorona L., Merced C. et al. Cervical pessary in pregnant women with a short cervix (PECEP): an open-label randomised controlled trial // Lancet. 2012. Vol. 379. No. 9828. P. 1800–1806. DOI: 10.1016/S0140-6736(12)60030-0

[23] ACOG Practice Bulletin No.142: Cerclage for the management of cervical insufficiency. Obstet Gynecol. 2014;123(2 Pt 1):372–379. DOI: 10.1097/01.AOG.0000443276.68274.cc

[24] ACOG Practice Bulletin No.142: Cerclage for the management of cervical insufficiency // Obstet. Gynecol. 2014. Vol. 123. No. 2. Pt. 1. P. 372–379. DOI: 10.1097/01.AOG.0000443276.68274.cc

[25] Romero R, Espinoza J, Erez O, Hassan S. The role of cervical cerclage in obstetric practice: can the patient who could benefit from this procedure be identified? Am J Obstet Gynecol. 2006;194(1):1–9. DOI: 10.1016/j.ajog.2005.12.002

[26] Romero R., Espinoza J., Erez O., Hassan S. The role of cervical cerclage in obstetric practice: can the patient who could benefit from this procedure be identified? // Am. J. Obstet. Gynecol. 2006. Vol. 194. No. 1. P. 1–9. DOI: 10.1016/j.ajog.2005.12.002

[27] Lim K, Butt K, Crane JM. No. 257-ultrasonographic cervical length assessment in predicting preterm birth in singleton pregnancies. J Obstet Gynaecol Can. 2018;40(2):e151–e164. DOI: 10.1016/j.jogc.2017.11.016

[28] Lim K., Butt K., Crane J.M. No. 257-ultrasonographic cervical length assessment in predicting preterm birth in singleton pregnancies // J. Obstet. Gynaecol. Can. 2018. Vol. 40. No. 2. P. e151–e164. DOI: 10.1016/j.jogc.2017.11.016

[29] Salomon LJ, Diaz-Garcia C, Bernard JP, Ville Y. Reference range for cervical length throughout pregnancy: non-parametric LMS-based model applied to a large sample. Ultrasound Obstet Gynecol. 2009;33(4):459–464. DOI: 10.1002/uog.6332

[30] Salomon L.J., Diaz-Garcia C., Bernard J.P., Ville Y. Reference range for cervical length throughout pregnancy: non-parametric LMS-based model applied to a large sample // Ultrasound Obstet. Gynecol. 2009. Vol. 33. No. 4. P. 459–464. DOI: 10.1002/uog.6332

[31] Conde-Agudelo A, Romero R, Nicolaides KH. Cervical pessary to prevent preterm birth in asymptomatic high-risk women: a systematic review and meta-analysis. Am J Obstet Gynecol. 2020;223(1):42–65.e2. DOI: 10.1016/j.ajog.2019.12.266

[32] Conde-Agudelo A., Romero R., Nicolaides K.H. Cervical pessary to prevent preterm birth in asymptomatic high-risk women: a systematic review and meta-analysis // Am. J. Obstet. Gynecol. 2020. Vol. 223. No. 1. P. 42–65.e2. DOI: 10.1016/j.ajog.2019.12.266

[33] Jin Z, Chen L, Qiao D, et al. Cervical pessary for preventing preterm birth: a meta-analysis. J Matern Fetal Neonatal Med. 2019;32(7):1148–1154. DOI: 10.1080/14767058.2017.1401998

[34] Jin Z., Chen L., Qiao D. et al. Cervical pessary for preventing preterm birth: a meta-analysis // J. Matern. Fetal Neonatal. Med. 2019. Vol. 32. No. 7. P. 1148–1154. DOI: 10.1080/14767058.2017.1401998

[35] Saccone G, Maruotti GM, Giudicepietro A, Martinelli P; Italian Preterm Birth Prevention (IPP) Working Group. Effect of cervical pessary on spontaneous preterm birth in women with singleton pregnancies and short cervical length: A randomized clinical trial. JAMA. 2017;318(23):2317-2324. [Published correction appears in JAMA. 2018;319(17):1824]. DOI: 10.1001/jama.2017.18956

[36] Saccone G., Maruotti G.M., Giudicepietro A., Martinelli P.; Italian Preterm Birth Prevention (IPP) Working Group. Effect of cervical pessary on spontaneous preterm birth in women with singleton pregnancies and short cervical length: A randomized clinical trial // JAMA. 2017. Vol. 318. No. 23. P. 2317–2324. DOI: 10.1001/jama.2017.18956

[37] Savel’eva GM, Shalina RI, Plekhanova ER, et al. Preterm labor: current problems. Russian bulletin of obstetrician-gynecologist. 2010;10(3):52–59. (In Russ.)

[38] Савельева Г.М., Шалина Р.И., Плеханова Е.Р. и др. Современные проблемы преждевременных родов // Российский вестник акушера-гинеколога. 2010. Т. 10. № 3. С. 52–59.

[39] MZ RF; OOO “Rossiyskoe obshchestvo akusherov-ginekologov” (ROAG), Assotsiatsiya akusherskikh anesteziologov-reanimatologov (AAAR). Prezhdevremennye rody. Klinicheskie rekomendatsii. 2020. (In Russ.). [cited 2022 March 17]. Available from: https://roag-portal.ru/recommendations_obstetrics

[40] МЗ РФ, ООО «Российское общество акушеров-гинекологов» (РОАГ), Ассоциация акушерских анестезиологов-реаниматологов (АААР). Преждевременные роды. Клинические рекомендации. 2020. [дата обращения 17.03.2022]. Доступ по ссылке: https://roag-portal.ru/recommendations_obstetrics

[41] Norman JE, Marlow N, Messow CM, et al. Does progesterone prophylaxis to prevent preterm labour improve outcome? A randomised double-blind placebo-controlled trial (OPPTIMUM). Health Technol Assess. 2018;22(35):1–304. DOI: 10.3310/hta22350

[42] Norman J.E., Marlow N., Messow C.M. et al. Does progesterone prophylaxis to prevent preterm labour improve outcome? A randomised double-blind placebo-controlled trial (OPPTIMUM) // Health Technol. Assess. 2018. Vol. 22. No. 35. P. 1–304. DOI: 10.3310/hta22350

[43] Medley N, Poljak B, Mammarella S, Alfirevic Z. Clinical guidelines for prevention and management of preterm birth: a systematic review. BJOG. 2018;125(11):1361–1369. DOI: 10.1111/1471-0528.15173

[44] Medley N., Poljak B., Mammarella S., Alfirevic Z. Clinical guidelines for prevention and management of preterm birth: a systematic review // BJOG. 2018. Vol. 125. No. 11. P. 1361–1369. DOI: 10.1111/1471-0528.15173

[45] Souza RT, Costa ML, Mayrink J, et al. Clinical and epidemiological factors associated with spontaneous preterm birth: a multicentre cohort of low risk nulliparous women. Sci Rep. 2020;10(1):855. DOI: 10.1038/s41598-020-57810-4

[46] Souza R.T., Costa M.L., Mayrink J. et al. Clinical and epidemiological factors associated with spontaneous preterm birth: a multicentre cohort of low risk nulliparous women // Sci. Rep. 2020. Vol. 10. No. 1. P. 855. DOI: 10.1038/s41598-020-57810-4

[47] Newman RB, Goldenberg RL, Iams JD, et al. Preterm prediction study: comparison of the cervical score and Bishop score for prediction of spontaneous preterm delivery. Obstet Gynecol. 2008;112(3):508–515. DOI: 10.1097/AOG.0b013e3181842087

[48] Newman R.B., Goldenberg R.L., Iams J.D. et al. Preterm prediction study: comparison of the cervical score and Bishop score for prediction of spontaneous preterm delivery // Obstet. Gynecol. 2008. Vol. 112. No. 3. P. 508–515. DOI: 10.1097/AOG.0b013e3181842087

[49] Ehsanipoor RM, Seligman NS, Saccone G, et al. Physical examination-indicated cerclage: A systematic review and meta-analysis. Obstet Gynecol. 2015;126(1):125–135. DOI: 10.1097/AOG.0000000000000850

[50] Ehsanipoor R.M., Seligman N.S., Saccone G. et al. Physical examination-indicated cerclage: A systematic review and meta-analysis // Obstet. Gynecol. 2015. Vol. 126. No. 1. P. 125–135. DOI: 10.1097/AOG.0000000000000850

[51] Morgan TK. Role of the placenta in preterm birth: A review. Am J Perinatol. 2016;33(3):258–266. DOI: 10.1055/s-0035-1570379

[52] Morgan T.K. Role of the placenta in preterm birth: A review // Am. J. Perinatol. 2016. Vol. 33. No. 3. P. 258–266. DOI: 10.1055/s-0035-1570379

[53] Katkova NYu, Bodrikova OI, Bezrukova IM, et al. Clinical and anamnestic features of different types of premature birth (retrospective review). Effective Pharmacotherapy. 2017;(26):12–17. (In Russ.)

[54] Каткова Н.Ю., Бодрикова О.И., Безрукова И.М. и др. Клинико-анамнестические особенности различных типов преждевременных родов (ретроспективный обзор) // Эффективная фармакотерапия. 2017. № 26. С. 12–17.

[55] Goldenberg RL, Culhane JF, Iams JD, Romero R. Epidemiology and causes of preterm birth. Lancet. 2008;371(9606):75–84. DOI: 10.1016/S0140-6736(08)60074-4

[56] Goldenberg R.L., Culhane J.F., Iams J.D., Romero R. Epidemiology and causes of preterm birth // Lancet. 2008. Vol. 371 (9606). P. 75–84. DOI: 10.1016/S0140-6736(08)60074-4

[57] Nguyen N, Savitz DA, Thorp JM. Risk factors for preterm birth in Vietnam. Int J Gynaecol Obstet. 2004;86(1):70–78. DOI: 10.1016/j.ijgo.2004.04.003

[58] Nguyen N., Savitz D.A., Thorp J.M. Risk factors for preterm birth in Vietnam // Int. J. Gynaecol. Obstet. 2004. Vol. 86. No. 1. P. 70–78. DOI: 10.1016/j.ijgo.2004.04.003

[59] McManemy J, Cooke E, Amon E, Leet T. Recurrence risk for preterm delivery. Am J Obstet Gynecol. 2007;196(6): 576.e1–6. DOI: 10.1016/j.ajog.2007.01.039

[60] McManemy J., Cooke E., Amon E., Leet T. Recurrence risk for preterm delivery // Am. J. Obstet. Gynecol. 2007. Vol. 196. No. 6. P. 576.e1–6. DOI: 10.1016/j.ajog.2007.01.039

[61] Chen CP, Wang KG, Yang YC, See LC. Risk factors for preterm birth in an upper middle class Chinese population. Eur J Obstet Gynecol Reprod Biol. 1996;70(1):53–59. DOI: 10.1016/s0301-2115(96)02555-9

[62] Chen C.P., Wang K.G., Yang Y.C., See L.C. Risk factors for preterm birth in an upper middle class Chinese population // Eur. J. Obstet. Gynecol. Reprod. Biol. 1996. Vol. 70. No. 1. P. 53–59. DOI: 10.1016/s0301-2115(96)02555-9

[63] Berkowitz GS, Blackmore-Prince C, Lapinski RH, Savitz DA. Risk factors for preterm birth subtypes. Epidemiology. 1998;9(3):279–285.

[64] Berkowitz G.S., Blackmore-Prince C., Lapinski R.H., Savitz D.A. Risk factors for preterm birth subtypes // Epidemiology. 1998. Vol. 9. No. 3. P. 279–285.

[65] Lo CC, Hsu JJ, Hsieh CC, et al. Risk factors for spontaneous preterm delivery before 34 weeks of gestation among Taiwanese women. Taiwan J Obstet Gynecol. 2007;46(4):389–394. DOI: 10.1016/S1028-4559(08)60008-X

[66] Lo C.C., Hsu J.J., Hsieh C.C. et al. Risk factors for spontaneous preterm delivery before 34 weeks of gestation among Taiwanese women // Taiwan J. Obstet. Gynecol. 2007. Vol. 46. No. 4. P. 389–394. DOI: 10.1016/S1028-4559(08)60008-X

[67] Esplin MS, O’Brien E, Fraser A, et al. Estimating recurrence of spontaneous preterm delivery. Obstet Gynecol. 2008;112(3):516–523. DOI: 10.1097/AOG.0b013e318184181a

[68] Esplin M.S., O’Brien E., Fraser A. et al. Estimating recurrence of spontaneous preterm delivery // Obstet. Gynecol. 2008. Vol. 112. No. 3. P. 516–523. DOI: 10.1097/AOG.0b013e318184181a

[69] Laughon SK, Albert PS, Leishear K, Mendola P. The NICHD Consecutive Pregnancies Study: recurrent preterm delivery by subtype. Am J Obstet Gynecol. 2014;210(2):131.e1–131.e1318. DOI: 10.1016/j.ajog.2013.09.014

[70] Laughon S.K., Albert P.S., Leishear K., Mendola P. The NICHD Consecutive Pregnancies Study: recurrent preterm delivery by subtype // Am. J. Obstet. Gynecol. 2014. Vol. 210. No. 2. P. 131.e1–131.e1318. DOI: 10.1016/j.ajog.2013.09.014

[71] Grimbizis GF, Camus M, Tarlatzis BC, et al. Clinical implications of uterine malformations and hysteroscopic treatment results. Hum Reprod Update. 2001;7(2):161–174. DOI: 10.1093/humupd/7.2.161

[72] Grimbizis G.F., Camus M., Tarlatzis B.C. et al. Clinical implications of uterine malformations and hysteroscopic treatment results // Hum. Reprod. Update. 2001. Vol. 7. No. 2. P. 161–174. DOI: 10.1093/humupd/7.2.161

[73] Heinonen PK, Saarikoski S, Pystynen P. Reproductive performance of women with uterine anomalies. An evaluation of 182 cases. Acta Obstet Gynecol Scand. 1982;61(2):157–162. DOI: 10.3109/00016348209156548

[74] Heinonen P.K., Saarikoski S., Pystynen P. Reproductive performance of women with uterine anomalies. An evaluation of 182 cases // Acta Obstet. Gynecol. Scand. 1982. Vol. 61. No. 2. P. 157–162. DOI: 10.3109/00016348209156548

[75] Reichman D, Laufer MR, Robinson BK. Pregnancy outcomes in unicornuate uteri: a review. Fertil Steril. 2009;91(5):1886–1894. [Published correction appears in Fertil Steril. 2015;103(6):1615–1618]. DOI: 10.1016/j.fertnstert.2008.02.163

[76] Reichman D., Laufer M.R., Robinson B.K. Pregnancy outcomes in unicornuate uteri: a review // Fertil. Steril. 2009. Vol. 91. No. 5. P. 1886–1894. DOI: 10.1016/j.fertnstert.2008.02.163

[77] Lin PC. Reproductive outcomes in women with uterine anomalies. J Womens Health (Larchmt). 2004;13(1):33–39. DOI: 10.1089/154099904322836438

[78] Lin P.C. Reproductive outcomes in women with uterine anomalies // J. Womens Health (Larchmt). 2004. Vol. 13. No. 1. P. 33–39. DOI: 10.1089/154099904322836438

[79] Chan YY, Jayaprakasan K, Tan A, et al. Reproductive outcomes in women with congenital uterine anomalies: a systematic review. Ultrasound Obstet Gynecol. 2011;38(4):371–382. DOI: 10.1002/uog.10056

[80] Chan Y.Y., Jayaprakasan K., Tan A. et al. Reproductive outcomes in women with congenital uterine anomalies: a systematic review // Ultrasound Obstet. Gynecol. 2011. Vol. 38. No. 4. P. 371–382. DOI: 10.1002/uog.10056

[81] Naeh A, Sigal E, Barda S, et al. The association between congenital uterine anomalies and perinatal outcomes – does type of defect matters? J Matern Fetal Neonatal Med. 2021;1–6. DOI: 10.1080/14767058.2021.1949446

[82] Naeh A., Sigal E., Barda S. et al. The association between congenital uterine anomalies and perinatal outcomes – does type of defect matters? // J. Matern. Fetal Neonatal. Med. 2021. No. 1–6. DOI: 10.1080/14767058.2021.1949446

[83] Bobkova MV, Puchko TK, Adamyan LV. Reproduction in women with congenital uterus and vagina anomalies. Russian Journal of Human Reproduction. 2018;24(2):42–53. (In Russ.). DOI: 10.17116/repro201824242-53

[84] Бобкова М.В., Пучко Т.К., Адамян Л.В. Репродуктивная функция у женщин с пороками развития матки и влагалища // Проблемы репродукции. 2018. Т. 24. № 2. С. 42–53. DOI: 10.17116/repro201824242-53

[85] Jakobsson M, Gissler M, Paavonen J, Tapper AM. Loop electrosurgical excision procedure and the risk for preterm birth. Obstet Gynecol. 2009;114(3):504–510. DOI: 10.1097/AOG.0b013e3181b052de

[86] Jakobsson M., Gissler M., Paavonen J., Tapper A.M. Loop electrosurgical excision procedure and the risk for preterm birth // Obstet. Gynecol. 2009. Vol. 114. No. 3. P. 504–510. DOI: 10.1097/AOG.0b013e3181b052de

[87] Pils S, Eppel W, Seemann R, et al. Sequential cervical length screening in pregnancies after loop excision of the transformation zone conisation: a retrospective analysis. BJOG. 2014;121(4):457–462. DOI: 10.1111/1471-0528.12390

[88] Pils S., Eppel W., Seemann R. et al. Sequential cervical length screening in pregnancies after loop excision of the transformation zone conisation: a retrospective analysis // BJOG. 2014. Vol. 121. No. 4. P. 457–462. DOI: 10.1111/1471-0528.12390

[89] Kristensen J, Langhoff-Roos J, Kristensen FB. Increased risk of preterm birth in women with cervical conization. Obstet Gynecol. 1993;81(6):1005–1008.

[90] Kristensen J., Langhoff-Roos J., Kristensen F.B. Increased risk of preterm birth in women with cervical conization // Obstet. Gynecol. 1993. Vol. 81. No. 6. P. 1005–1008.

RIGHTS & PERMISSIONS

Eсо-Vector