Selection of the method for correction of cervical incompetence

Abstract

Cervical incompetence (CI) is one of the challenges of modern obstetrics. The practicing obstetrician-gynecologist faces a complex task of timely diagnosis, selection of correction method, timing of application and removal of cerclage. The problem of CI in pregnancy is known from the XIX century, but in the XI century, the outstanding scientist Abu Ali Ibn Sina (Avicenna) wrote about this pathology. According to the classical definition, CI is the softening, widening and shortening of the cervix prior to the 37th week of gestation in the absence of thretening termination of pregnancy. CI is characterized by inability to carry a pregnancy to full-term due to functional or structural abnormalities of the uterine cervix. To date, no objective diagnostic tests exists to identify patients at high risk of developing CI, not before and not during pregnancy. A high diagnostic accuracy during pregnancy can be reached with transvaginal ultrasound of the cervix. The ultrasound scale proposed by Salomon LJ allows to measure the length of the cervix depending on the gestational age and assists in making the right choice for the correction of short cervix. The selection of the method of correction of CI depends on the clinical situation, history, timing of gestation, the number of fetuses, cervicometry data, gynecological examination, the threat of abortion, and the doctor’s experience. There are two main methods of correction of CI: conservative and surgical. Surgical methods include transvaginal and transabdominal cerclage, while conservative includes adherence to bed rest, tocolytics, hormonal therapy, and the use of obstetric pessaries. Insertion of obstetric pessaries is a promising, safe, simple method of treatment and prevention of CI and for threatening termination of pregnancy in the II and III trimesters. The strategy of widespread use of pessaries in pregnant women from high-risk groups can reduce the frequency of preterm labor and improve perinatal outcomes.