Clinical features of isthmic-cervical insufficiency associated with cervicovaginal infections

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OBJECTIVE

To determine clinical and diagnostic features of isthmic-cervical insufficiency (ICI) associated with cervicovaginal infections.

MATERIAL AND METHODS

A total of 100 pregnant women with ICI at gestational age 14—28 weeks were included in a prospective cohort study. All pregnant women were divided into 2 groups after transvaginal ultrasound cervicometry and comprehensive clinical and laboratory examination: 72 pregnant women with cervicovaginal infections constituted the 1st (main) group, 28 pregnant women with vaginal normocenosis were included in the 2nd group (comparison group).

RESULTS

Only 13.9% (10) of pregnant women with ICI in group 1 had no complaints, whereas in group 2, 50% (14) of the subjects had no clinical symptoms (p<0.001). In patients with ICI associated with cervicovaginal infections, the prothrombotic state of hemostasis was found significantly more often — in 56.9% (41) of pregnant women, in group 2 — in 32.1% (9) patients (p=0.026). The blood biochemical study showed a significant increase in the level of C-reactive protein in the group of women with ICI associated with cervicovaginal infections up to 9.45±1.28 mg/l, both in relation to physiological parameters and in comparison, with group 2 — 3.89±1.56 mg/l (p=0.006). In ICI associated with cervicovaginal infections, «short cervix» (group 1 — 43.1% of patients, group 2 — 21.4%) and cervical dilatation >10 mm throughout without shortening of the cervical length (group 1 — 12.5% of patients, group 2 — 0) were diagnosed significantly more often than in the comparison group. In group 2, cervical shortening combined with Y/V-shaped dilatation of the internal cervical os was most common (group 1 — 12.5% of patients, group 2 — 35.7%; p=0.008).

CONCLUSION

The observed clinical and laboratory features in women with cervicovaginal infection-associated ICI may be related to the presence of intrauterine infection in this cohort. The differences detected by ultrasound cervicometry may reflect the pathogenetic features of the cervical remodelling process depending on the cause of ICI.

Keywords:

isthmic-cervical insufficiency

cervicovaginal infections

pregnancy

Authors:

Dolgushina V.F.

South Ural State Medical University

ORCID: 0000-0002-3929-7708

Alikhanova E.S.

South Ural State Medical University

ORCID: 0000-0002-8814-1478

Kurnosenko I.V.

South Ural State Medical University

ORCID: 0000-0003-2309-2983

Grafova E.D.

South Ural State Medical University

ORCID: 0000-0001-9983-0108

Received:

02.06.2023

Accepted:

23.06.2023

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