Prevention of preterm birth: Novel interventions for the cervix

Abstract

Preterm birth is the leading cause of neonatal mortality and morbidity worldwide. Spontaneous preterm birth is a complex, multifactorial condition in which cervical dysfunction plays an important role in some women. Current treatment options for cervical dysfunction include cerclage and supplemental progesterone. In addition, cervical pessary is being studied in research protocols. However, cerclage, supplemental progesterone and cervical pessary have well known limitations and there is a strong need for alternate treatment options. In this review, we discuss two novel interventions to treat cervical dysfunction: (1) injectable, silk protein-based biomaterials for cervical tissue augmentation (injectable cerclage) and (2) a patient-specific pessary. Three-dimensional computer simulation of the cervix is performed to provide a biomechanical rationale for the interventions. Further development of these novel interventions could lead to new treatment options for women with cervical dysfunction.

Emergency Cervical Cerclage

“…Cervical failure is related to its premature ripening. The processes of shortening and dilatation of the cervix are physiological processes during labor but when initiated before 37 weeks of pregnancy, miscarriage, or premature birth may occur [ 11 , 21 , 22 ]. Several factors are implicated in cervical insufficiency including: congenital changes in the internal structure of the cervix, acquired mechanical injuries, and inflammatory processes, leading to its early shortening and dilatation [ 23 ].…”

Recurrence rate of preterm birth and associated factors among women who delivered at Kilimanjaro Christian Medical Centre in Northern Tanzania: A registry based cohort study

“…Numerous factors have been associated with an increased risk of PTB and its recurrence. These include history of preterm birth, low maternal body mass index, pre-eclampsia, placenta previa, and short cervical length [12,13]. Furthermore, genital infection, multiple gestation, short interpregnancy interval, uterine anomalies, smoking, black race, raised fetal fibronection concentration, psychological stress, stressful working condition, poor living condition, low level of education and maternal unemployment status have aso been associated with an increased risk of PTB and its recurrence [14][15][16].…”

O uso do pessário na prevenção do parto prematuro em gestantes com colo uterino curto: revisão narrativa

“…Pessários são dispositivos endovaginais majoritariamente utilizados no manejo de prolapsos do assoalho pélvico como alternativa à abordagem cirúrgica (KOULLALI B, et al, 2017b). Nas últimas décadas, sua aplicação também vem sendo avaliada no contexto das gestações de risco elevado para prematuridade, mais especificamente naquelas em que o aumento do risco se dá em função de um comprimento cervical curto (HOOFT J, et al, 2018).…”

“…A causa do parto prematuro é multifatorial, e a disfunção cervical é um fator fisiopatológico importante em algumas mulheres (KOULLALI B, et al, 2017b). Além disso, um parto prematuro anterior aumenta em duas vezes o risco de o próximo parto também ser pré-termo (CROWTHER CA, et al, 2017).…”

“…O pessário cervical é um dispositivo de silicone, originalmente utilizado como tratamento para prolapsos, e que atualmente vêm sendo usado para a prevenção do nascimento prematuro, pois auxilia a manutenção do fechamento do colo do útero, aplicando uma força de contato externa que leva ao fechamento do canal cervical. Assim, ocorre a redução do estiramento do tecido interno e o aumento da compressão do tecido externo (KOULLALI B, et al, 2017b).…”