Management of women with cervical insufficiency - transformation of views

Abstract

Cervical cerclage is an obstetric procedure used to prevent late term spontaneous abortions and preterm birth in women at high risk of miscarriage. Taking into consideration existance of insufficient effectiveness of methods for preventing spontaneous preterm labor, as evidenced by the lack of significant changes in statistical data over the past 10 years, further research is needed to improve the tactics of managing pregnant women, especially from the group of high risk of this complication. Cervical cerclage allows to mechanically stop the process of spontaneous opening of the cervix, however, although the method is minimally invasive, when using it, there is still a risk of complications, such as infection or trauma to the cervix. Taking this into account, determining the groups of patients who will benefit the most from this intervention is essential. Today, this issue is undergoing a number of transformations and updates which we tried to analyze in this work. Aim - determining changes in the recommendations for surgical management of women with isthmico-cervical insufficiency based on the analysis of the latest recommendations of the National Institute for Health and Care Excellence and the Royal College of Obstetricians and Gynecologists. Results and conclusions. According to the 2022 guidelines, along with slightly changed approaches to the classification and terminology of cervical cerclage, there has been some transformation in views about the groups of women who will benefit the most from the procedure. First of all, according to anamnestic data, cervical suture is recommended for three anamnestic episodes of miscarriage instead of two in the previous recommendations. On ultrasound examination, a wedge-shaped transformation of the cervix and incidental detection of cervical shortening after 20 weeks is not an indication for applying a cerclage, since the effectiveness of the intervention in this case is unproven. In addition, new techniques, such as abdominal cerclage, have been invented to more effectively prevent episodes of miscarriage. No conflict of interests was declared by the authors.