Changes in management tactics and treatment outcomes of patients with isthmic-cervical insufficiency in the second decade of the 21st century based on the results of research at the Surgut District Clinical Centre for Maternal and Child Health Care

Belotserkovtseva L.D.

Surgut District Clinical Centre for Maternal and Childhood Care;
Surgut State University

ORCID: 0000-0001-6995-4863

Ivannikov S.E.

Surgut State University

ORCID: 0000-0001-8292-1820

Mirzoeva G.T.

Surgut District Clinical Centre for Maternal and Childhood Care

ORCID: 0000-0002-8218-4194

Parfenova A.V.

Surgut State University

ORCID: 0000-0002-7480-4912

Changes in management tactics and treatment outcomes of patients with isthmic-cervical insufficiency in the second decade of the 21st century based on the results of research at the Surgut District Clinical Centre for Maternal and Child Health Care

Authors:

Belotserkovtseva L.D., Ivannikov S.E., Mirzoeva G.T., Parfenova A.V.

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Journal: Russian Bulletin of Obstetrician-Gynecologist. 2024;24(1): 47‑53

DOI: 10.17116/rosakush20242401147

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To cite this article:

Belotserkovtseva LD, Ivannikov SE, Mirzoeva GT, Parfenova AV. Changes in management tactics and treatment outcomes of patients with isthmic-cervical insufficiency in the second decade of the 21st century based on the results of research at the Surgut District Clinical Centre for Maternal and Child Health Care. Russian Bulletin of Obstetrician-Gynecologist. 2024;24(1):47‑53. (In Russ.)
https://doi.org/10.17116/rosakush20242401147

Подписка 2025-2 (Russian Bulletin of Obstetrician-Gynecologist)

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OBJECTIVE

To improve the course and outcomes of pregnancy in patients with isthmic-cervical insufficiency (ICI) by optimizing the management tactics.

MATERIAL AND METHODS

An open, retrospective, observational, comparative study was conducted. Pregnant women who received inpatient treatment for ICI were divided into 2 groups: pregnancy and delivery in 2011 (group 1, n=110) and in 2019 (group 2, n=138). Exclusion criteria: congenital malformations, multiples, no data of pregnancy outcome. The course of pregnancy and peculiarities of delivery were analyzed.

RESULTS

Pregnant women of both groups had a high frequency of complicated obstetric anamnesis: the number of miscarriages, habitual miscarriage, births before 28 and before 32 weeks. Infectious processes in the genital system were observed with the same frequency. There were changes in the methods of correction: the frequency of pessary use increased from 38.2 to 49.3%, the frequency of surgical cerclage decreased from 56.9 to 1.4%, and the use of gestagens alone increased 10-fold from 4.9 to 49.3% (p<0.001). The number of term deliveries increased from 72.7 to 83.3% with a concomitant trend towards a decrease in spontaneous abortions from 4.5 to 3.6% and preterm deliveries from 22.7 to 13.0% (p=0.116). There was a marked decrease in the incidence of chorioamnionitis from 4.5 to 0.7% (p=0.091) and a significant decrease in premature rupture of the fetal membranes (PRFE) from 46.4 to 20.7% (p<0.001), largely due to a decrease in the incidence of PRFE at gestational age up to 37 weeks.

CONCLUSION

The change in the management of pregnant women with ICI was manifested by a decrease in the use of cerclage with a simultaneous increase in the use of pessaries and gestagens alone. This made it possible to maintain the number of term deliveries, to reduce the frequency of chorioamnionitis by more than 4 times and PRPO, which was 2 times more associated with a decrease in the frequency of PRPO at gestational age up to 37 weeks.

Keywords:

gestagens

isthmic-cervical insufficiency

pessary

preterm labor

premature rupture of fetal membranes

cerclage

chorioamnionitis

Authors:

Belotserkovtseva L.D.

Surgut District Clinical Centre for Maternal and Childhood Care;
Surgut State University

ORCID: 0000-0001-6995-4863

Ivannikov S.E.

Surgut State University

ORCID: 0000-0001-8292-1820

Mirzoeva G.T.

Surgut District Clinical Centre for Maternal and Childhood Care

ORCID: 0000-0002-8218-4194

Parfenova A.V.

Surgut State University

ORCID: 0000-0002-7480-4912

Received:

30.05.2023

Accepted:

29.06.2023

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