Isthmic-cervical insufficiency. Predicting the efficacy of correction methods

Objective. To identify factors that reduce and improve the efficacy of correction. Patients and methods. A retrospective study was conducted, including the analysis of prenatal records and obstetrics history of patients with confirmed diagnosis of isthmic-cervical insufficiency (ICI) (n = 291). Depending on pregnancy outcomes, all patients were divided into 2 groups: group 1 (n = 84) included pregnant women with no effect of ICI correction and preterm labor (less than 258 days). Group 2 consisted of 207 patients with an effect of correction and labor at term. Medical records of pregnant women, their complaints, data of clinical, laboratory and instrumental examinations during pregnancy and at hospitalization were analyzed. A comparative assessment of perinatal outcomes of newborns was performed. Results. This study showed that the most optimal correction methods for ICI are laparoscopic cerclage (100%), obstetric pessary (87%) and transvaginal cerclage (67%). The main factor of efficacy is an initial cervical length. The incidence of preterm labor at critical cervical length <15 mm was 65.5% and >20 mm was 12% (p = 0.001) (OR: 7.61; 95% CI: 0.705–0.816). The following significantly reduced the efficacy of ICI correction: chronic ENT diseases (OR: 3.577; 95% CI: 2.048–6.249); obesity (OR: 4.944; 95% CI: 2.845–8.593); recurrent miscarriage (OR: 2.855; 95% CI: 1.409–5.783); history of preterm labor (OR: 2.492; 95% CI: 1.284–4.836); inflammatory changes on bacterioscopy (OR: 1.439; 95% CI: 0.861–2.406), detection of opportunistic microflora (OM) (OR: 1.988; 95% CI: 1.185–3.334), lack of Lactobacillus spp. (OR: 1.397; 95% CI: 0.826–2.363) in the vaginal bacterial community. Conclusion. Timely diagnosis of cervical shortening and treatment of concomitant pathology are important to improve the efficacy of ICI correction. It is optimal to perform additional cervicometry at 16–18 weeks’ gestation in all pregnant women, not only in those at risk. Patients diagnosed with ICI should undergo mechanical correction of the cervix before it shortens to 15 mm. The most optimal length for correction is 19 mm or more, with a 6.7-fold reduction in the risk of early pregnancy loss, which improves perinatal outcomes. Pharmacotherapy with progesterone medications can be prescribed as an addition to the main treatment or for the prevention of ICI. Key words: isthmic-cervical insufficiency, pregnancy, cervicometry, vaginal microbiota, correction methods, opportunistic microflora, intrauterine pneumonia, cervix, fetal bladder prolapse