MANAGEMENT OF PREGNANT WOMEN WITH CERVICAL INSUFFICIENCY

Abstract

The cervical insufficiency (CI) of functional and organic genesis leads to pregnancy loss and premature birth in 14.3-65.0% of cases. To date, the question of the effectiveness of various methods of correction ofthe CI is disputeable.The goal of the work was to compare the effectiveness of various methods of management of pregnant women with CI.Material and methods. Under observation there were 161 pregnant women with CI: 43 women in whom the correction of CI was performed by Dr. Arabin’s obstetric perforated pessary together with taking 200 mg of vaginal micronized progesterone twice a day until 37 weeks of pregnancy; 41 pregnant women who received treatment with CI only with a pessary; 42 patients who received treatment with CI only with vaginal micronized progesterone 200 mg twice a day until 37 weeks of gestation; 35 pregnant women with CI with expectant management. The control group K consisted of 30 pregnant women without CI and threatened abortion. All pregnant women underwent cervicometry, vaginal examination with an assessment of the structural changes in the cervix, taking into account the data of anamnesis on the Steinber scale. The pessary was installed with a score of 5 points or more in gestational age of 12-18 weeks.Results and discussion. Premature births of up to 37 weeks of pregnancy with correction by pessary + progesterone occurred in 4.65% of women, which was less common than in the correction group of the CI only with the pessary 4.72 times (21.95%, OR 0.27, 95% CI 0.04-0.86) and only vaginal progesterone – 5.12 times (23.81%, OR 0.16, 95% CI 0.03-0.76), and with waiting-waiting management tactics – 9, 83 times (45.71% OR, 0.06, 95% CI, 0.01-0.28).Conclusions. The best way to manage pregnant women with CI is the joint use of Dr. Arabin’s perforated obstetric pessary and micronized vaginal progesterone at a dose of 200 mg twice a day until the 37th week of pregnancy.