The Short Cervix Management as a Prevention Method of Preterm Birth QC05-QC09
Dr. Aizada Marat,
Beibitshilik str., 49A, Astana, Astana, Kazakhstan.
Introduction: Preterm birth is considered to be the most common cause of antenatal mortality and further newborns’ morbidity in the world. The majority of children, who are born before physiologically normal term, suffer from long-term unfavourable consequences of the preterm births. Therefore, there is a strong demand on effective medically tested and proved mechanisms of decreasing the preterm birth coefficient. In the following survey, the short cervix has been identified as a significant predictor of preterm birth. Thus, its management helps find relevant solution in reducing the level of preterm birth.
Aim: To assess the effectiveness of: 1) the Arabin obstetric pessary; 2) cerclage (surgical management of the cervix by Lyubimova and Mammadaliyeva); 3) intravaginal micronised progesterone 200 mg affecting to the short cervix with purpose of the preterm birth prevention; to confirm the achieved results by the method of transvaginal cervicometry.
Materials and Methods: A total of 125 women were included in the study. Obstetric pessary was used in 62 women Group I, cerclage was done in 31 women Group II and vaginal progesterone was used in 32 women Group III to treat the short cervix. The results of short cervix management methods were assessed according to the comparison of pregnancy outcomes between groups.
Results: Comparison of pregnancy outcomes between group I and group II did not reveal notable statistical differences in the rates of urgent labour if taken into account the premature births over 34 weeks and interruptions of pregnancy with less than 22 weeks. Nevertheless, there were significantly more frequent cases of premature births on the term of less than 34 weeks (CI (95%) 13.7-18.4) in group II (p<0.05). Indicatively, more often premature births within the term of less than 34 weeks occurred in groups II and III, comparing with the group I. Comparison of the outcomes of pregnancy in groups II and III did not demonstrat significant statistical differences between them.
Conclusion: Application of the Arabin obstetric pessary, the cerclage and progesterone has an equal effectiveness for women with the short cervix, singleton pregnancy and with the history of preterm birth. There were no registered cases of extremely early preterm births. In order to determine the effective methods of the short cervix correction, further randomised control trials with broad number of participants should be conducted.