Analysis of risk factors and predictors of pregnancy loss and strategies for the management of cervical insufficiency in pregnant women at a high risk of preterm birth

Aim: To identify risk factors and predictors of pregnancy loss and to compare the efficacy of Arabin’s pessary with cervical cerclage in women at a high risk of pregnancy loss. Materials and methods: This was a two-center retrospective case-control study that included 240 women at a high risk of preterm delivery. Group I (n = 161) included women who underwent insertion of the Arabin’s pessary between 14 and 24 weeks of pregnancy. Group II (n = 79) included women who had undergone circular cervical cerclage during the current pregnancy. All women included in the study received micronized vaginal progesterone at the dose of 200 mg/day until and including 34 weeks of gestation. Results: Threatened pregnancy loss defined as spotting or vaginal bleeding in the first trimester was diagnosed in 29.8% (48/161) of patients in Group I versus 37.9% in Group II (p =.448). Postpartum bleeding occurred in 8.1% (13/161) in women in Group I versus 22.8% in Group II (χ2 = 6.500; p =.011). Our study showed that cervical cerclage was most suitable for patients with history of obstetric complications, cervical length <15 mm, and large isthmic uterine fibroids. The use of the Arabin’s pessary reduced the rate of preterm births by 1.7-fold. A cluster analysis demonstrated that predictors of preterm birth in women with a high risk of pregnancy loss included: threatened pregnancy loss associated with chorionic/placental abruption, cervical incompetence, uterine fibroid growth to a large size, history of multiple spontaneous pregnancy losses, cervical tears during past labor, and gestational diabetes diagnosed for the first time during the current pregnancy. Conclusions: Women with a high risk of pregnancy loss treated with Arabin’s pessary or cerclage plus vaginal progesterone had a term delivery rate of 70.4% (169/240). The combined strategy of pregnancy management allowed to markedly reduce the number of preterm births. © 2019, © 2019 Informa UK Limited, trading as Taylor & Francis Group.

Barinov S.V.1 , Artymuk N.V.2 , Novikova O.N.2 , Shamina I.V.1 , Tirskaya Y.I.1 , Belinina A.A.3 , Lazareva O.V. 1 , Kadcyna T.V.1 , Borisova A.V. 1, 5 , Stepanov S.S.1 , Di Renzo G.C.
Taylor and Francis Ltd
  • 1 2nd Department of Obstetrics and Gynaecology, Omsk State Medical University, Omsk, Russian Federation
  • 2 Department of Obstetrics and Gynecology named after Professor G.A. Ushakova, Kemerovo State Medical University, Kemerovo, Russian Federation
  • 3 Altai State Clinical Perinatal Centre, Barnaul, Russian Federation
  • 4 Department of Obstetrics and Gynecology and Centre for Reproductive and Perinatal Medicine, The University of Perugia, Perugia, Italy
  • 5 Peoples Friendship University of Russia (RUDN) Moscow, Russian Federation
Ключевые слова
Cervical incompetence; circular cervical cerclage; obstetric hemorrhage; obstetric pessary; placenta previa; preterm birth
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