Сervical insufficiency after timely childbirth - what went wrong?

Abstract

Premature birth is a serious global medical problem. About 15 million premature babies are born annually in the world, of which 1 million dies. Spontaneous premature birth is a cause of 40-45% of all premature births. Cervical insufficiency (CI) is a significant risk factor for spontaneous premature birth. Purpose - to identify the risk factors for the development of CI in patients with a history of full-term pregnancies to draw attention to the problem of underdiagnosis of hidden obstetric injuries. Materials and methods. During 2021 – June 2023, a retrospective cohort study was conducted in the municipal non-profit enterprise “Kyiv Perinatal Center”, within which 140 patients were analyzed. The study group includes 70 patients who have a history of at least one full-term pregnancy, and who had a diagnosis of CI during the last pregnancy. The control group consisted of patients who had 2 or more pregnancies, during which they were not diagnosed with CI. Results. The odds of developing CI during the next pregnancy increased compared with the control group in the presence of the following: rapid delivery - up to ≈4:1; prolonged second stage of labour - up to ≈6.5:1; cervical surgery with cervical dilatation - up to ≈4.7:1; cervical surgery without cervical dilatation - up to ≈4.1:1. Previous spontaneous preterm delivery was not found to be a predictor of CI development at subsequent pregnancies. Conclusions. The results show that patients with precipitous delivery and surgical manipulations on the cervix in history have at least 4 times higher the risk of CI development after timely childbirth, and with a prolonged second period of childbirth - have 6.5 times higher risk. It should be noted that statistically significant differences were not found in patients who had spontaneous preterm delivery. We also postulate that such data indicate two possible phenotypes of the CI: one is of traumatic genesis, and the second is of congenital tendency of the cervix to weakness, which can first manifest in the form of precipitous childbirth, and subsequently manifest in the form of CI. The research was carried out in accordance with the principles of the Declaration of Helsinki. The research protocol was approved by the Local Ethics Committee of the institution mentioned in the work. Informed consent of the women was obtained for the research. No conflict of interests was declared by the authors.