Cervical insufficiency: search for additional predictors and prognosis possibilities

• Tatiana V. Rachenkova
• Yulia A. Dudareva
• Valentina A. Gureva

Abstract

The prevalence of cervical insufficiency during pregnancy is 0.8–1%, while in 15–40% it is caused by late spontaneous miscarriage. Despite the fact that this problem has been well studied and approaches to its correction are known, the incidence of this pathology and adverse pregnancy outcomes does not decrease.

The aim of the study was to identify additional predictors and approaches to predicting cervical insufficiency (CI).

Material and methods. A retrospective cross-sectional (single-stage) comparative study was conducted based on the analysis of data from 80 women. The groups are divided as follows: the main group (n=50) – patients whose pregnancy ended in late spontaneous miscarriage at 10–21.6 weeks against the background of cervical shortening ≤25 mm and/or dilatation of cervical canal ≥10 mm; control group (n=30) – patients with a physiological pregnancy that ended in term birth. An analysis of clinical and anamnestic data of the patients, fetal ultrasound, cervicometry, laboratory tests and subsequent statistical processing of data were carried out to identify risk factors for late spontaneous miscarriage against the background of CI.

Results. When analyzing somatic pathology, it was revealed that patients of the main group more often suffered from iron deficiency anemia, diseases of the gastrointestinal tract and obesity, and their obstetric history was more often burdened by spontaneous miscarriages and premature births. Pregnancy in patients of the main group was 2.0 times more likely to be accompanied by a disturbance in the vaginal biocenosis. After ranking risk factors by significance according to the Fisher–Snedecor statistic, the most significant ones were identified: anemia, a history of non-developing pregnancy, gastrointestinal pathology, a history of spontaneous miscarriage, impaired vaginal microbiocenosis, obesity and premature birth.

Conclusion. The main directions in the prevention of late spontaneous miscarriages against the background of CI within the framework of personalized preconception preparation and management of pregnancy are normalization of weight, correction of nutrition and lifestyle, timely detection and treatment of gastrointestinal diseases and intestinal dysbiosis, iron deficiency anemia, diagnosis and treatment of disorders of the vaginal biocenosis, cervicometry with 15 to 24 weeks of pregnancy once every 7–14 days, administration of vaginal forms of progesterone up to 20 weeks of pregnancy in a high-risk group.

Keywords: cervical insufficiency; late spontaneous miscarriage; risk factors; iron deficiency anemia; intestinal dysbiosis

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