DOI: https://doi.org/10.22263/2312-4156.2022.5.56
E.A. Mitskevich1, T.S. Divakova1, M.F. Razina2, Y.V. Meleshko3
Risk factors for spontaneous miscarriage and preterm birth in patients with isthmic-cervical insufficiency
1Vitebsk State Order of Peoples’ Friendship Medical University, Vitebsk, Republic of Belarus
2Novopolotsk Central City Hospital, Novopolotsk, Republic of Belarus
3Vitebsk City Polyclinic No.7, Vitebsk, Republic of Belarus
Vestnik VGMU. 2022;21(5):56-68.
Abstract.
Objectives. To define the factors that determine spontaneous miscarriage and preterm birth in pregnant women with isthmic-cervical insufficiency (ICI), to develop recommendations for providing medical care depending on the individual risk.
Material and methods. The object of the study was 300 pregnant women with ICI (main group) and their newborns: subgroup 1 – 91 patients with spontaneous miscarriage and ICI, subgroup 2 – 106 patients with preterm labor and ICI, subgroup 3 – 103 patients with term labor and ICI. The control group (subgroup 4) consisted of 100 women with term labor without ICI. All patients received treatment in Vitebsk region hospitals in 2016-2022.
Results. The anamnestic data, the features of the current pregnancy course, the results of laboratory and instrumental diagnostic methods, the effectiveness of a vaginal cerclage, an obstetric pessary, and a hormonal method of treating ICI were studied. An assessment of the influence of the studied factors on the timing of the completion of pregnancy, the morbidity of newborns and the need for the second stage of nursing was made. Risk factors for ICI and factors influencing pregnancy outcomes in ICI in the 2nd and the 3rd trimesters have been established, which will enable the prediction of gestational complications, timely performing of primary and secondary prevention of miscarriage, and improvement of perinatal morbidity rates.
Conclusions. A high risk of spontaneous miscarriage in patients with ICI is determined by the following risk factors: ≥ 3 deliveries; history of premature birth; ICI in the anamnesis; severe undifferentiated connective tissue dysplasia (UCTD); hyperprolactinemia; cervical dysplasia during the current pregnancy; asymptomatic bacteriuria during the current pregnancy; cervical length ≤25 mm at 16 weeks of gestation. Risk factors for preterm delivery against the background of ICI during the current pregnancy are: severe UCTD; cervical length ≤25 mm at 22 weeks of gestation. To reduce the likelihood of spontaneous miscarriage in patients with ICI the use of prophylactic progesterone; dynamic ultrasonic cervicometry; diagnosis and treatment of asymptomatic bacteriuria; prophylactic vaginal cerclage when the cervical length is 25-30 mm at 14-16 weeks of pregnancy may be useful. To reduce the rate of preterm birth in patients with ICI prophylactic administration of progesterone; dynamic ultrasonic cervicometry; prophylactic vaginal cerclage when the cervical length is 25-30 mm at 20-22 weeks of pregnancy may be recommended.
Keywords: isthmic-cervical insufficiency, spontaneous miscarriage, premature labor, personalized medicine.
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Information about authors:
E.A. Mitskevich – Candidate of Medical Sciences, associate professor, head of the Chair of Obstetrics & Gynecology of the Faculty for Advanced Training & Retraining, Vitebsk State Order of Peoples’ Friendship Medical University,
E-mail: Этот адрес электронной почты защищён от спам-ботов. У вас должен быть включен JavaScript для просмотра. – Ekaterina A. Mitskevich;
T.S. Divakova – Doctor of Medical Sciences, professor of the Chair of Obstetrics & Gynecology of the Faculty for Advanced Training & Retraining, Vitebsk State Order of Peoples’ Friendship Medical University;
M.F. Razina – obstetrician-gynecologist, head of the maternity hospital, Novopolotsk Central City Hospital;
Y.V. Meleshko – obstetrician-gynecologist, Vitebsk City Polyclinic No.7.
