Perinatal consequences of innovative tactics for the treatment of recurrent miscarriage in isthmic-cervical insufficiency

Abstract

Purpose - to improve the effectiveness of the treatment of miscarriage due to isthmic-cervical insufficiency (ICI) by using improved management tactics for women at high risk of ICI. Materials and methods. A two-stage innovating tactic for the treatment of miscarriage caused by ICI was proposed, including the prediction of the ineffectiveness of vaginal cerclage and the implementation of transabdominal cerclage in certain groups of patients. Starting from the pregravid stage, 30 women at risk of ICI were examined, which were conducted according to the developed scheme. 2 patients with a history of failed vaginal cerclage had abdominal cerclage prior to pregnancy and had not yet become pregnant at the time of writing. In 28 remaining women, the course and results of pregnancy were monitored. 3 patients after trachelectomy for cervical cancer were given abdominal cerclage in early pregnancy. 23 pregnant women were subjected to vaginal cerclage prophylactically or for sonographic or physical indications, these women constituted the main group for evaluating the effectiveness of the proposed treatment regimen for miscarriage in ICI. The comparison group consisted of 80 women with intravaginal cerclage, who were managed according to the protocols of the Ministry of Health of Ukraine. Results. The effectiveness of the proposed tactics for the treatment of miscarriage caused by ICI reflects the frequency of miscarriage and its structure. No cases of late miscarriages were observed. The rate of preterm birth significantly decreased from 37.5% to 21.7% (p<0.05), while no cases of early preterm birth (before 28 weeks) were observed. In the structure of miscarriage, 80.0% is the proportion of preterm births at 34-36 weeks of gestation (against 35.5%; p<0.05). The frequency of premature rupture of membranes decreased by 4 times (8.7% vs. 36.3%; p<0.05). The frequency of birth of children in a state of asphyxia decreased by more than 2 times (17.4% vs. 43.4%; p<0.05), and there was not a single case of birth in a state of severe asphyxia. The incidence of complications in the early neonatal period decreased by 20% (43.5% vs. 63.2%; p<0.05), mainly due to a decrease in the frequency of such dangerous complications as respiratory distress syndrome (13.0% vs. 31.6%; p<0.05) and disorders of central nervous system (17.4% vs. 44.7%; p<0.05). Conclusions. The use of the proposed tactics for the treatment of miscarriage caused by CI made it possible to significantly reduce the frequency of miscarriage and improve its structure, avoid cases of spontaneous miscarriages and neonatal deaths, improve the condition of newborns, which makes it possible to recommend the introduction of this tactic in the practical work of obstetric and gynecological institutions. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of the participating institution. The informed consent of the patient was obtained for conducting the studies. No conflict of interests was declared by the authors.