The effectiveness of correction methods for isthmic-cervical insufficiency: cohort study results

Abstract

AIM: To assess the pregnancy outcomes in patients with isthmic-cervical insufficiency (ICN) and the effectiveness of modern methods of correction, namely cervical cerclage, obstetric discharge pessary, and progesterone preparations.

MATERIALS AND METHODS: The retrospective analysis included 184 females with ICN, who were divided into three groups based on ICN correction methods: 1st group consisted of 82 (44.6%) females who were corrected by cervical cerclage; 2nd group with 67 (36.4%) females by obstetric pessary; and 3rd group with 35 (19.0%) females by progesterone therapy with ICN sign appearance.

RESULTS: According to the obtained data, every second patient (53.3%) in our study had risk factors for ICN development due to the mechanical expansion of the cervical canal in cervical anamnesis. In most cases, ICN was diagnosed in 20 weeks and more, and the median period of correction was 21 [20–22] weeks in 1st group, 24 [22–26] weeks in 2nd group, and 22 [20–22] weeks in 3rd group (p <0.001). The overall incidence of preterm birth (PTB) in 1st group was 48.8%, whereas 40.3% in 2nd group and 60% in 3rd group. The share of timely births accounted for 41.5% in 1st group, whereas 53.7% in 2nd group and 11.4% in 3rd group.

CONCLUSION: Correction of ICN with cervical cerclage and obstetric pessary showed similar effectiveness and allowed prolonged pregnancy to more favorable terms. The correction group with only progesterone preparations noted a high frequency of premature pregnancy termination since this group initially included females with a higher risk of PTB and adverse factors for further prolonged pregnancy.

Keywords

preterm birth / isthmic-cervical insufficiency / cervical cerclage / obstetric pessary / progesterone

References

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