Incompetence of the Cervix

McDonald, Ian A.

doi:10.1111/j.1479-828x.1978.tb00008.x

Cited by 33 publications

(14 citation statements)

References 23 publications

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“…Pregnancy complicated by painless dilatation and shortening of the cervix during the second trimester has been treated for many years by cervical cerclage (Shirodkar 1955 ;McDonald 1957McDonald , 1980. In addition, some obstetricians consider that improved fetal survival can be achieved by inserting a suture electively before cervical weakness becomes demonstrable (Kuhn & Pepperell 1977;McDonald 1978McDonald , 1980Harger 1980). So far, no experimentally derived evidence is available to justify such practice.…”

mentioning

confidence: 99%

A randomized controlled trial of cervical cerclage in women at high risk of spontaneous preterm delivery

Rush

Isaacs

McPherson

et al. 1984

BJOG

240

102

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Summary. The effect of cervical suture on pregnancy outcome was studied in 194 women with a high risk (approximately 30%) of having a late abortion or a preterm delivery. The women were randomly allocated either to have a cervical suture inserted (n=96) or to be managed without a suture (n=98). There was no evidence that cervical cerclage either prolonged gestation or improved survival. Patients allocated to receive cerclage spent significantly longer in hospital, even when the period of admission for insertion was excluded. The patients in the cerclage group were more likely to receive tocolytic drugs, and more of them experienced puerperal pyrexia, although these differences between the groups were not statistically significant.

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mentioning

confidence: 99%

A randomized controlled trial of cervical cerclage in women at high risk of spontaneous preterm delivery

Rush

Isaacs

McPherson

et al. 1984

BJOG

240

102

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“…One might suspect that not all the 332 index pregnancies had true cervical incompetence, or that a proportion had had a suture inserted in previous pregnancies. The time at which the suture was inserted varied widely and although similar to other retrospective series (Seppala & Vara 1970;Laurensen & Fuchs 1973;Kuhn & Pcpperell 1977) it was often outside the generally recommended gestation of 12-16 (Robboy 1973;McDonald 1978) or 14-18 weeks (Kuhn & Pepperell 1977). In the latter studies it was conceded that signs of dilation or shortening of the cervix during pregnancy sometimes made a late insertion of suture necessary (Robboy 1973;Kuhn & Pepperell 1977;McDonald 1978), but in this series only 35% of cases had an insertion of suture between 12 and 16 weeks, and 24% between 14 and 13 weeks.…”

Section: Discussionmentioning

confidence: 61%

“…The time at which the suture was inserted varied widely and although similar to other retrospective series (Seppala & Vara 1970;Laurensen & Fuchs 1973;Kuhn & Pcpperell 1977) it was often outside the generally recommended gestation of 12-16 (Robboy 1973;McDonald 1978) or 14-18 weeks (Kuhn & Pepperell 1977). In the latter studies it was conceded that signs of dilation or shortening of the cervix during pregnancy sometimes made a late insertion of suture necessary (Robboy 1973;Kuhn & Pepperell 1977;McDonald 1978), but in this series only 35% of cases had an insertion of suture between 12 and 16 weeks, and 24% between 14 and 13 weeks. It is somewhat surprising that the timing of insertion of the suture did not appear to influence significanlly the risk of pregnancy ending prematurely, expcricnce which is at variance with Lhe series described by Kuhn & Pepperell (1 977) where cervical suture between 14 and 18 weeks led to a lower premature delivery rate than later suture.…”

Section: Discussionmentioning

confidence: 61%

Cervical suture in Scotland: strengths and weaknesses in the use of routine clinical summaries

Cole

1982

BJOG

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Summary. National routinely collected hospital data for 12 months from June 1976 were used to provide information on patients with cervical suture during pregnancy. The past obstetric history and outcome of the pregnancy after suture was contrasted with the experience of all pregnant women during the same year. The nature of the data did not allow adequate examination of any change in the rate of fetal wastage, before and after suture; or in the secular change in fetal wastage in the pregnant population. After cervical suture the rates of both premature delivery and of perinatal mortality were higher than in the general pregnant population. The perinatal mortality rate in the cervical suture group showed a greater improvement after suture than was seen to occur between previous and current pregnancies in the whole population, although the excess improvement in pregnancy outcome that occurred after cervical suture could not be definitely ascribed to the suture.

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“…Согласно классическому определению для ист-мико-цервикальной недостаточности харак-терно размягчение, расширение и укорочение шейки матки до 37-й недели беременности при отсутствии угрозы прерывания. ИЦН обычно проявляется с безболезненной, прогрессив-ной дилатации шейки матки во II или в начале III триместра, которое приводит к пролапсу, инфицированию и преждевременному разрыву плодных оболочек, прерыванию беременности или преждевременным родам [1][2][3][4][5]. Этот диа-гноз традиционно ставится пациентам с исто-рией повторных самопроизвольных абортов во II триместре и/или ранних преждевремен-ных родов, у которых основной механизм за-ключается в «неспособности шейки матки оставаться закрытой» [6].…”

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Selection of the method for correction of cervical incompetence

et al. 2017

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■ Истмико-цервикальная недостаточность (ИЦН) является одной из важных проблем современного акушерства.Перед практикующим акушером-гинекологом стоит сложная задача своевременной диагностики, выбора метода коррекции, сроков наложения и удаления серкляжа. Проблема несостоятельности шейки матки при беремен-ности известна с XIX в., но еще в XI в. выдающийся ученый Абу Али Ибн Сина (Авиценна) писал об этой пато-логии. Согласно классическому определению ИЦН -это размягчение, расширение и укорочение шейки матки до 37-й недели гестации при отсутствии угрозы прерывания. Для ИЦН характерна неспособность женщины доносить беременность до доношенного срока из-за функционального или структурного дефекта шейки матки. На настоящее время не существует объективных диагностических тестов для выявления пациенток высоко-го риска развития ИЦН ни до и ни во время беременности. Высокой диагностической значимостью во время беременности обладает трансвагинальное ультразвуковое исследование шейки матки. Разработанная ультра-звуковая шкала L.J. Salomon позволяет оценить длину шейки матки в зависимости от срока гестации и сделать врачу правильный выбор для коррекции короткой шейки. Выбор метода коррекции ИЦН зависит от клиниче-ской ситуации, анамнеза, сроков гестации, числа плодов, данных цервикометрии, гинекологического осмотра, угрозы прерывания беременности, опыта врача. Существует два основных метода коррекции ИЦН: консерва-тивный и хирургический. К хирургическим методам относятся трансвагинальный и трансабдоминальный сер-кляж, а к консервативным -соблюдение постельного режима, токолитическая, гормональная терапия, приме-нение акушерского пессария. Установка акушерских пессариев является перспективным безопасным простым методом лечения и профилактики ИЦН и угрозы прерывания беременности во II и III триместрах. Стратегия широкого использования пессариев у беременных из групп высокого риска позволяет снизить частоту прежде-временных родов и улучшить перинатальные исходы.■ Ключевые слова: истмико-цервикальная недостаточность (ИЦН); серкляж; трансвагинальный серкляж; трансабдоминальный серкляж; акушерский пессарий Arabin; трансвагинальное УЗИ; преждевременные роды. ■ 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 d...

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Incompetence of the Cervix

Cited by 33 publications

References 23 publications

A randomized controlled trial of cervical cerclage in women at high risk of spontaneous preterm delivery

A randomized controlled trial of cervical cerclage in women at high risk of spontaneous preterm delivery

Cervical suture in Scotland: strengths and weaknesses in the use of routine clinical summaries

Selection of the method for correction of cervical incompetence

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