Differentiated approach to the correction of short cervix in women with a history of anovulatory infertility according to the results of ultrasound elastography

Abstract

Today, the problem of miscarriage around the world is especially relevant on the background of increasing infertility. One of its causes is isthmic-cervical insufficiency and the «short cervix» syndrome, which is increasingly claimed in modern literature. The objective: was determination of cervical elastography parameters in women with a history of "short cervix" syndrome and anovulatory infertility and selection of the method of correction depending on the type of elastogram. Materials and methods. The main group included 25 women with singleton pregnancies that occurred after treatment of anovulatory infertility by in vitro fertilization (IVF), who were diagnosed with a short cervix according to transvaginal cervicometry during the first prenatal screening. The control group consisted of 20 healthy pregnant women. Results. Analyzing the results of ultrasound elastography of the cervix, it was found that in the main group mixed type of elastogram was observed in 14 (56.00%) patients, mild type in 11 (44.00%), while in women of the control group all cervical tissue was dense, indicating a rigid type of elastogram. When determining the coefficient of deformation, a significant difference in the area of interest (area of the inner eye and cervical canal) between the two groups was noted. Patients with a mixed type of cervical elastogram underwent prophylactic mechanical correction of cervical changes by applying an obstetric discharge pessary, and pregnant women with a mild type of cervical elastogram - cervical cerclage was applied with mercylen tape. The majority of pregnant women in the main group had a timely delivery (92.00%), only two (8.00%) patients had a premature birth within 34-36 weeks +6 days of gestation (one woman with different correction methods). Conclusions. Іn women with short cervix, who became pregnant after treatment of anovulatory infertility with IVF, there is a significant decrease in cervical tissue density, which should be considered as a prognostic criterion for isthmic-cervical insufficiency, and therefore miscarriage requires mechanical correction by applying a prophylactic suture to the cervix or the installation of an obstetric pessary, depending on the type of elastogram of the cervix.