Isthmicocervical insufficiency: Diagnosis and correction

Astrakhantseva M.M.; Breusenko L.E.; Lebedev E.V.; Plekhanova E.R.; Savel'eva G.M.; Shalina R.I.

doi:https://doi.org/10.17116/rosakush201616283-88

Astrakhantseva M.M.

Department of Obstetrics and Gynecology, Faculty of Pediatrics, N.I. Pirogov Russian National Research Medical University, Ministry of Health of Russia;
Center for Family Planning and Reproduction, Moscow Healthcare Department, Moscow

Breusenko L.E.

Kafedra akusherstva i ginekologii pediatricheskogo fakul'teta Rossiĭskogo natsional'nogo issledovatel'skogo meditsinskogo universiteta im. N.I. Pirogova

Lebedev E.V.

Kafedra akusherstva i ginekologii pediatricheskogo fakul'teta Rossiĭskogo gosudarstvennogo meditsinskogo universiteta, Moskva

Plekhanova E.R.

Kafedra akusherstva i ginekologii pediatricheskogo fakul'teta Rossiĭskogo gosudarstvennogo meditsinskogo universiteta, Moskva

Savel'eva G.M.

Kafedra akusherstva i ginekologii pediatricheskogo fakul'teta Rossiĭskogo gosudarstvennogo meditsinskogo universiteta, kafedra akusherstva i ginekologii fakul'teta fundamental'noĭ meditsiny Moskovskogo gosudarstvennogo universiteta im. M.V. Lomonosova

Shalina R.I.

Kafedra akusherstva i ginekologii pediatricheskogo fakul'teta Rossiĭskogo gosudarstvennogo meditsinskogo universiteta, Moskva

Isthmicocervical insufficiency: Diagnosis and correction

Authors:

Astrakhantseva M.M., Breusenko L.E., Lebedev E.V., Plekhanova E.R., Savel'eva G.M., Shalina R.I.

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Journal: Russian Bulletin of Obstetrician-Gynecologist. 2016;16(2): 83‑88

DOI: 10.17116/rosakush201616283-88

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To cite this article:

Astrakhantseva MM, Breusenko LE, Lebedev EV, Plekhanova ER, Savel'eva GM, Shalina RI. Isthmicocervical insufficiency: Diagnosis and correction. Russian Bulletin of Obstetrician-Gynecologist. 2016;16(2):83‑88. (In Russ.)
https://doi.org/10.17116/rosakush201616283-88

Подписка 2026 Российский вестник акушера-гинеколога (Russian Bulletin of Obstetrician-Gynecologist)

Использование инфографики авторами научных работ

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Abstract:

Objective — to identify risk factors for isthmicocervical insufficiency (ICI) and to determine the possibilities of its timely diagnosis and correction in the second trimester of pregnancy. Subject and methods. The prospective study enrolled 257 patients with monocyesis in the second trimester (at 13—27 weeks’ gestation). Among them, 93 patients were admitted to a gynecology department with a diagnosis of ICI. The inclusion criteria into a study group (n=76) were ICI symptoms established from the data of transvaginal echography and manual examination and more frequently detected at 16—22 weeks’ gestation. Ultrasound study failed to reveal cervical shortening in 17 examinees who were excluded from analysis. 164 women had physiological pregnancy without changes in the cervix uteri (a control group). The degree of IC was estimated using a rating scale. ICI was corrected in 70 (92.1%) out of the 76 examinees in the study group: the McDonald cervical cerclage was carried out in 41 (58.6%) patients before 22 weeks’ gestation; an obstetrical pessary was placed in 29 (41.4%) pregnant women after 22 weeks’ gestation. Furthermore, two methods (surgical correction and obstetric pessary use) were sequentially employed in 3 (4.3%) examinees. Results. ICI correction was effective in 66 (94.3%) out of the 70 patients treated for ICI, including in 1 out of the 2 examinees having a cervical length of 10 mm. Deliveries at term occurred in 62 (88.6%) patients and 4 (5.7%) babies were born at 34—36 weeks’ gestation. Eight (11.5%) out of the 70 patients gave birth prematurely. Full-term babies were born to 35 (85.4%) patients who had undergone cervical cerclage. Preterm deliveries occurred in 6 (14.6%) patients; odds ratio (OR) was 0.10; 95% confidence interval (CI), 0.02—0.94): in 2 before 32 weeks, in 4 at 34—36 weeks. After obstetric pessary application, delivery at term occurred in 27 (93.1%); premature delivery did in 2 (6.9%) before 28 weeks (OR 0.14; 95% CI 0.014—1.23). Conclusion. The cervix uteri should be evaluated in all pregnant women, including those in the group at risk for premature birth, beginning at week 16. The timely detection of ICI and its adequate correction are effective, as these promote longer pregnancy up to more than 34 weeks in 94% of the patients. The authors declare no conflicts of interest.

Keywords:

isthmicocervcal insufficiency

uterine cervical length

cervical cerclage

obstetric pessary

Authors:

Astrakhantseva M.M.

Breusenko L.E.

Kafedra akusherstva i ginekologii pediatricheskogo fakul'teta Rossiĭskogo natsional'nogo issledovatel'skogo meditsinskogo universiteta im. N.I. Pirogova

Lebedev E.V.

Kafedra akusherstva i ginekologii pediatricheskogo fakul'teta Rossiĭskogo gosudarstvennogo meditsinskogo universiteta, Moskva

Plekhanova E.R.

Kafedra akusherstva i ginekologii pediatricheskogo fakul'teta Rossiĭskogo gosudarstvennogo meditsinskogo universiteta, Moskva

Savel'eva G.M.

Shalina R.I.

Kafedra akusherstva i ginekologii pediatricheskogo fakul'teta Rossiĭskogo gosudarstvennogo meditsinskogo universiteta, Moskva

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