No. 373-Cervical Insufficiency and Cervical Cerclage

Brown, Richard N; Gagnon, Robert; Delisle, Marie-France

doi:10.1016/j.jogc.2018.08.009

Cited by 98 publications

(110 citation statements)

References 128 publications

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“…Вагітність різко обмежує кількість дозволених до використання препаратів. Однак добре відомо, що в сучасних умовах моноінфекція зустрічається дуже рідко (8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27),5%, за даними різних авторів), тому виникає потреба в антимікробних препаратах, що відповідають таким вимогам: нешкідливість під час вагітності; бактерицидна дія на широкий спектр патогенів, безпека для плода; висока ефективність; зручність застосування; доступність.…”

Section: гінекологіяunclassified

“…У посівах із цервікального каналу приблизно у 50% жінок визначається умовно-патогенна мікрофлора (частіше ентерококи, різні неспоротворні анаероби -бактероїди, пептострептококи), причому в більшості з них виявляються бактерії -бактерійні та бактерійно-вірусні асоціації. Вважається, що патогенна вагінальна та інтрацервікальна мікрофлора сприяє звільненню фосфоліпази А2, яка стимулює синтез простагландинів і веде до активації процесів дозрівання шийки матки (вкорочення, розм'якшення тощо) і дострокового переривання вагітності [12][13][14][15].…”

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Prevention and treatment of bacterial vaginosis in pregnant women with isthmic-cervical insufficiency

Романенко

Суліменко

2020

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Purpose of the study was to evaluate the effectiveness of clindamycin in combination with metronidazole and miconazole in complex therapy in pregnant women suffering from vaginal dysbiosis with ischemic-cervical insufficiency with threat of premature birth, which used an unloading obstetric pessary.Materials and methods. 100 pregnant women with bacterial vaginosis in the III trimester of pregnancy with isthmic-cervical insufficiency, threat of premature birth and using of an obstetric pessary were examined. 50 women of group I (comparison) received therapy according to the orders of the Ministry of Health of Ukraine, and 50 women of group II (main) used the treatment and preventive measures proposed by study authors, which included Banbact® suppositories for 3 days, and then Gynex® Forte complex drug for 7 days, after which a probiotic of 7 days was prescribed.Results of the study. The clinical effect of treatment in main group was achieved in 100% of cases. The amniotest was negative in all cases after treatment. In both groups was a slight shift to the alkaline side of the vaginal contents (pH 5.0–5.5), in the comparison group 2.5 times more often than in the main one. A significant decrease in the vaginal pH was observed in persons of group II after treatment at 37–38 weeks of pregnancy, no increase in pH >5.5 was detected; pH shift to the alkaline side was observed 3.5 times more often in group I.Most pregnant women in both groups achieved normocenosis after treatment. However, in group I a moderately expressed leukocyte reaction, the prevalence of leukocytes over epithelial cells, and a decrease in normal vaginal flora were noted 2.4 times more often (p <0.05). In 10.0% of pregnant women in group I single spores and pseudo mycelium of fungi, coccal or mixed flora were revealed against the background of a moderate leukocyte reaction (p <0.05).A pronounced leukocyte reaction was retained in 6 (12.0%) women of group II at 37–38 weeks, accompanied by a delay in the fetus development. Mixed flora persisted 3.7 times more often in women of group I. 22 species of microorganisms were identified in group I in the third trimester, while in pregnant women of group II – 14 species.Conclusions. The study revealed the high efficiency of complex treatment for bacterial vaginosis and normalization of the genital tract microflora in the third trimester in pregnant women with isthmic-cervical insufficiency. This helped to reduce the frequency of the threat of abortion, development of placental insufficiency, and delayed fetal development. The clinical efficacy of Banact® and Ginex® Forte was combined with their good tolerance; therefore these drugs are safe during pregnancy, which allows them to be used in practical obstetrics.

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Section: гінекологіяunclassified

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Prevention and treatment of bacterial vaginosis in pregnant women with isthmic-cervical insufficiency

Романенко

Суліменко

2020

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“…[1,2] It is defined as the insufficiency of cervix to maintain the pregnancy without the symptoms and indications of uterine contraction and labor during the second trimester. [3] Actual cervical insufficiency is seen in less than 1% of the obstetric population, [4] and it is responsible for 8% of the recurring gestational losses. [5] Although there is no diagnostic test for the cervical insufficiency, its diagnosis is established by the previous history and physical examination as well as ruling out other potential reasons and by the ultrasonographic measurement of cervical length recently.…”

Section: Introductionmentioning

confidence: 99%

“…[5] Although there is no diagnostic test for the cervical insufficiency, its diagnosis is established by the previous history and physical examination as well as ruling out other potential reasons and by the ultrasonographic measurement of cervical length recently. [3,4,6] Even though there are other diagnostic tests such as hysterosalpingography, balloon traction, and the insertion of cervical dilatators, the scientific evidences do not support their uses in the diagnosis of cervical insufficiency. [3] The surgical methods such as McDonald and Shirodkar procedures as well as non-surgical methods without proven efficiency (such as bedrest, activity restriction, vaginal ring) are used in the treatment of cervical insufficiency.…”

Section: Introductionmentioning

confidence: 99%

The effects of cervical cerclage practice on perinatal and neonatal outcomes according to the indications

Kaya¹,

Güner²,

Şi̇mşek³

et al. 2020

Perinatal J

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Objective: The aim was to investigate the perinatal and neonatal outcomes in the cases which underwent cervical cerclage, and to compare the elective and emergency cerclage cases. Methods: The cases that underwent cervical cerclage in the Hospital of the Faculty of Medicine at Akdeniz University between January 2014 and December 2019 were assessed retrospectively, and separated into 3 categories as the prophylactic, elective and emergency groups. The demographic characteristics and perinatal and neonatal outcomes were recorded and they were compared between the groups. Results: A total of 92 cases with singleton pregnancy between 12 and 24 weeks of gestation were included in the study. The prophylactic cerclage group consisted of 48 cases, the elective cerclage group consisted of 21 cases and the emergency cerclage group consisted of 23 cases. The rate of the cases delivered at term (≥37 weeks of gestation) was found significantly lower in the emergency cerclage group than the rates of the cases in the prophylactic and elective cerclage groups (26.1%, 70.8% and 66.7%; respectively). While there was no significant difference between the prophylactic and elective cerclage groups in terms of premature preterm labor (<32 weeks of gestation), the rate of premature preterm labor was significantly higher in the emergency cerclage group than two other groups (10.4%, 9.5% and 43.5%, respectively; p=0.005). The mean delivery week of the emergency cerclage cases was significantly higher than the prophylactic and elective cerclage groups (31.7, 36.7 and 36.5 weeks, respectively; p<0.001). The mean duration between the cerclage procedure and the delivery week was the highest in the prophylactic cerclage cases and the lowest in the emergency cerclage cases (22.8 and 9.7 weeks, respectively; p<0.001). The mortality rate of the newborns was higher in the emergency cerclage cases than the other groups, which was statistically significant (p=0.002). Conclusion: We concluded that the perinatal and neonatal outcomes of the emergency cerclage procedure carried out in the advanced stage of cervical changes in the cases with cervical insufficiency is less successful than the prophylactic and elective cerclage procedures. The early detection of cervical insufficiency by the previous history, the physical examination and the measurement of transvaginal cervical length and responding at the early weeks of gestation may improve the perinatal and neonatal outcomes.

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“…Esta patología se presenta entre el 0,5 a 1% de los embarazos (2,3,4) .La mejor manera que tenemos para manejar esta condición es la detección precoz de ella. El cerclaje cervical es una intervención que ha demostrado su utilidad en el tratamiento de la incompetencia cervical entendida de esta manera clásica.…”

Section: Introductionunclassified