Combined method of the cervical insufficiency correction: Dr. Arabin vaginal perforated obstetric pessary and various forms of tableted micronized progesterone

Abstract

Objectives: a comparative assessment of the effectiveness of a combined therapeutic and prophylactic method for cervical insufficiency (CI) correcting by using Dr. Arabin vaginal perforated obstetric pessary and various forms of tableted micronized progesterone – vaginal and sublingual.Material and methods. 215 pregnant women with CI were under observation. The main group included 129 pregnant women with CI, in whom therapeutic and preventive measures included a combination of obstetric perforated pessary by Dr. Arabin and sublingual form of micronized progesterone 100 mg three times a day up to 36 weeks of pregnancy. The compression group included 86 pregnant women with CI treated with Dr. Arabin vaginal perforated obstetric pessary and micronized progesterone vaginal tablets 200 mg twice daily up to 36 weeks’ gestation. All women during the gestational period also received vitamin-mineral complexes for pregnant women, ω3-polyunsaturated fatty acids and magnesium preparations.Course of pregnancy, obstetric and perinatal consequences were assessed.Results. The study of combined methods in the CI correction led to similar results in pregnancy outcomes and childbirth: there was no statistically significant difference between the main group and comparison group in the frequency of premature rupture of membranes (χ2 = 6.65% vs. 0.47), labor before 32 weeks (1.55 versus 4.65%, χ2 = 1.83, p = 0.18) labor in 33–36 weeks (4.65 versus 6.98%, χ2 = 0.53, p = 0.47), emergency labor (93.80 versus 88.37%, χ2 = 1.98, p = 0.16), operative delivery by cesarean section (13.95 vs. 2.33% versus 6.98%, χ2 = 2.78, p = 0.10), bleeding in the postpartum period (2.33 vs. 6.98%, χ2 = 2.78, p = 0.10), neonatal morbidity (4.65 versus 10.47%, χ2 = 2.69, p = 0.10), low birth weight – less than 1,500 g (1.55 vs. 5.81%, χ2 = 2.98, р = 0.08), middleweight babies (3,420.24 ± 48.98 vs. 3,360.23 ± 66.38 g, p = 0.47). Comparing the compliance of treatment and preventive measures was established that women in labor in the obstetric pessary + sublingual progesterone group rated them at 9.19 ± 0.11 points, in the obstetric pessary + vaginal progesterone group – at 7.83 ± 0.0.01 points).Conclusions. Combined methods of CI correction using Dr. Arabin vaginal perforated obstetric pessary in combination with tableted micronized progesterone are effective and safe when using both vaginal and sublingual forms of progesterone. But the method of using a pessary and sublingual progesterone is more optimal, convenient and compliant. Both techniques can be widely used in clinical practice.