Donald School Journal of Ultrasound in Obstetrics and Gynecology

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VOLUME 11 , ISSUE 3 ( July-September, 2017 ) > List of Articles

REVIEW ARTICLE

Cervical Incompetence: Modern Clinical Protocols and Real Practice

Larisa D Belotserkovtseva, Ludmila V Kovalenko, Sergey E Ivannikov, Gulnora T Mirzoeva, Tatiana G Petrova

Keywords : Cervical cerclage,Cervical incompetence,Cervical pessary,Clinical protocol,Preterm delivery,Ultrasound cervicometry

Citation Information : Belotserkovtseva LD, Kovalenko LV, Ivannikov SE, Mirzoeva GT, Petrova TG. Cervical Incompetence: Modern Clinical Protocols and Real Practice. Donald School J Ultrasound Obstet Gynecol 2017; 11 (3):203-209.

DOI: 10.5005/jp-journals-10009_1524

License: CC BY-NC 4.0

Published Online: 01-03-2016

Copyright Statement:  Copyright © 2017; The Author(s).


Abstract

Objective

The objective is to evaluate efficiency of using internal protocol of prophylaxis preterm birth (PB).

Materials and methods

Three hundred and seventy gravidas without clinical symptoms of preterm delivery with cervical canal length of <25 mm and on <21 gestation weeks were inspected. Protocol included anamnesis research, 200 mg of daily vaginal progesterone, ultrasound monitoring of length and shape of cervical canal, and distinguished treatment of cervical insufficiency using cerclage or cervical pessary.

Results

Gravidas whose protocol was fully attended have more than dual-fold decrease of extra early preterm delivery risk ratio [4.3 vs 12.3% relative risk (RR) 0.47; 95% confidence interval (CI) 0.23–0.99], compared with those whose protocol was attended fractionary. Quantity of unprompted miscarriages in 22+0 week period also decreased dual-fold (6.6 vs 13.8%; RR 0.47; 95% CI 0.23–0.99). The most common mistakes were ignorance of anamnesis data, wrong choice of ways of correction cervical insufficiency, long and ineffective treatment of genital tract infections, and inaccurate estimation of cervical canal.

Summary

Usage of effective medication, development of new clinical protocols, and detailed abidance of earlier accepted protocols, mistakes’ analysis, and staff training are reserves of extremely PB decrease.

How to cite this article

Belotserkovtseva LD, Kovalenko LV, Ivannikov SE, Mirzoeva GT, Petrova TG. Cervical Incompetence: Modern Clinical Protocols and Real Practice. Donald School J Ultrasound Obstet Gynecol 2017;11(3):203-209.


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  1. Born too soon: the global action report on preterm birth. In: Howson CP, Kinney MV, Lawn JE, editors. March of Dimes, PMNCH, Save the Children. Geneva: World Health Organization; 2012.
  2. Recurrence risk for preterm delivery. Am J Obstet Gynecol 2007 Jun;196(6):576.e1-576.e7.
  3. Pregnancy outcomes after assisted reproductive technology. Joint SOGC-CFAS Guideline no. 173, March 2007. J Obstet Gynaecol Can 2006;173:222-233.
  4. ; Norwitz, E. Risk factors for preterm labor and delivery. 2007. [cited 2007 Dec 17]. Available from: http://www.uptodate.com/contents/risk-factors-for-pretermlabor-and-delivery.
  5. Cervical length at 23 weeks of gestation: relation to demographic characteristics and previous obstetric history. Ultrasound Obstet Gynecol 1998 Nov;12(5):304-311.
  6. Ultrasound assessment of cervical length in threatened preterm labor. Ultrasound Obstet Gynecol 2003 Jun;21(6):552-555.
  7. The prediction of recurrent preterm birth in patients on 17-alpha-hydroxyprogesterone caproate using serial fetal fibronectin and cervical length. Am J Obstet Gynecol 2012 Jul;207(1):51.e1-51.e5.
  8. Accuracy of cervical transvaginal sonography in predicting preterm birth: a systematic review. Ultrasound Obstet Gynecol 2003 Sep;22(3):305-322.
  9. Prenatal administration of progesterone for preventing preterm birth in women considered to be at risk of preterm birth. Cochrane Database Syst Rev 2013 Jul;7:CD004947.
  10. Cervical cerclage for prevention of preterm delivery in women with short cervix: randomised controlled trial. Lancet 2004 Jun;363(9424):1849-1853.
  11. Effectiveness of cerclage according to severity of cervical length shortening: a meta-analysis. Ultrasound Obstet Gynecol 2010 Apr;35(4):468-473.
  12. Preventing preterm births: analysis of trends and potential reductions with interventions in 39 countries with very high human development index. Lancet 2013 Jan;381(9862):223-234.
  13. Cervical pessary in pregnant women with a short cervix (PECEP): an open-label randomised controlled trial. Lancet 2012 May;379(9828):1800-1806.
  14. Cerclage pessary for preventing preterm birth in women with a singleton pregnancy and a short cervix at 20 to 24 weeks: a randomized controlled trial. Am J Perinatol 2013 Apr;30(4):283-288.
  15. Vaginal progesterone, cerclage or cervical pessary for preventing preterm birth in asymptomatic singleton pregnant women with a history of preterm birth and a sonographic short cervix. Ultrasound Obstet Gynecol 2013 Feb;41(2):146-151.
  16. Limitations of early diagnosis of cervical failure for prophylaxis of extremely preterm delivery. Veliky Novgorod (NovSU) 2015;85(2):117-124.
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