The association of chronic endometritis with mid-trimester loss due to cervical incompetence and the outcome of laparoscopic cervical cerclage

Li, Jian; Song, Dongmei; Feng, Xiangdong; Huang, Xiaowu; Xia, Enlan; Li, Tin‐Chiu

doi:10.1007/s00404-021-06029-3

Cited by 4 publications

(6 citation statements)

References 20 publications

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“…(3) The infection risk of transvaginal surgery is higher than that of abdominal surgery. (4) Cervical dysfunction caused by abortion or premature delivery in the second trimester is related to chronic endometritis [22]. Laparoscopic cervical cerclage before pregnancy is beneficial to improve the microecology of endometrium before pregnancy and facilitate embryo implantation and development.…”

Section: Discussionmentioning

confidence: 99%

Effect of different surgical routes on pregnancy outcome of history-indicated cervical cerclage

Qin

Yang

Zhou

et al. 2023

Arch Gynecol Obstet

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Objective To study the guiding significance of medical history on laparoscopic and vaginal cervical cerclage in the treatment of cervical incompetence and its influence on pregnancy outcome. Methods A total of 53 cases by laparoscopic abdominal cervical cerclage (LAC group) before pregnancy and 73 cases by transvaginal cervix cerclage (TVC group) at 12–14 weeks of pregnancy were collected. Multivariate logistic regression analysis was performed on the influencing factors of delivery gestational weeks. Furthermore, the gestational weeks after cervical cerclage were compared between the two groups with high- and low-risk grades. Results The number of previous uterine cavity operations in LAC group was more than that TVC group, and the costs of operation were more than TVC group. At the same time, the hospitalization days and operation time were longer than those in TVC group, and the delivery rate of cesarean section was higher than TVC group, but the total hospitalization times were less than TVC group (P < 0.05). The rate of delivery before 34 weeks of pregnancy and the incidence of premature rupture of membranes or premature labor in LAC group were lower than those in TVC group (P < 0.05). In TVC group, the increased number of prior PTB or STL and the history of cervical cerclage failure would increase the risk of premature delivery before 34 weeks of pregnancy. There was no increased risk of preterm delivery before 34 weeks of pregnancy in LAC group (P > 0.05). According to the risk level, in the high-risk group, the delivery rate of LAC group at gestational weeks < 37 weeks, < 34 weeks and < 28 weeks was lower than that of TVC group. Conclusion Laparoscopic cervical cerclage might be more effective in preventing premature delivery before 34 weeks of gestation, and its influence on delivery gestational weeks was not affected by related medical history. For high-risk patients with the history of prior PTB or STL and failed cerclage, laparoscopic cervical cerclage might be more effective than vaginal cervical cerclage in preventing extremely preterm before 28 weeks, premature delivery before 34 weeks and premature delivery before 37 weeks. Therefore, our limited experience suggested that LAC can be a recommended option for patients with high-risk history.

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Section: Discussionmentioning

confidence: 99%

Effect of different surgical routes on pregnancy outcome of history-indicated cervical cerclage

Qin

Yang

Zhou

et al. 2023

Arch Gynecol Obstet

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“…3) The infection risk of transvaginal surgery is higher than that of abdominal surgery. 4) Cervical dysfunction caused by abortion or premature delivery in the second trimester is related to chronic endometritis [21] . Laparoscopic cervical cerclage before pregnancy is bene cial to improve the microecology of endometrium before pregnancy and facilitate embryo implantation and development.…”

Section: Discussionmentioning

confidence: 99%

Effect of different surgical routes on pregnancy outcome of history-indicated cervical cerclage

Qin

Zhou²,

Yang³

et al. 2022

Preprint

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Objective To study the guiding significance of medical history on laparoscopic and vaginal cervical cerclage in the treatment of cervical incompetence and its influence on pregnancy outcome. Methods A total of 53 cases of cervical cerclage by laparoscopy before pregnancy (laparoscopic group) and 73 cases of preventive cervical cerclage by vagina (vaginal group) at 12–14 weeks of pregnancy were collected. Multivariate logistic regression analysis was performed on the influencing factors of delivery gestational weeks. To further compare the difference of delivery gestational weeks after cervical cerclage between laparoscopic group and vaginal group with high and low risk levels. Results The number of previous uterine cavity operations in laparoscopic group was more than that in vaginal group, the hospitalization days and operation time were longer than those in vaginal group, the delivery rate of cesarean section was higher than that in vaginal group, but the total hospitalization times were less than that in vaginal group(P < 0.05). The rate of delivery before 34 weeks of pregnancy and the incidence of premature rupture of membranes or premature labor in laparoscopic group were lower than those in vaginal group(P < 0.05). In the vaginal group, the increased number of prior PTB or STL and the history of cervical cerclage failure will increase the risk of premature delivery before 34 weeks of pregnancy. There was no significant difference in the influence of laparoscopic history on delivery before 34 weeks of pregnancy(P > 0.05). According to the risk level, in the high-risk group the delivery rate of laparoscopic group at gestational weeks < 37 weeks, < 34 weeks and < 28 weeks was lower than that of vaginal group. Conclusion Laparoscopic cervical cerclage is more effective in preventing premature delivery before 34 weeks of gestation, and its influence on delivery gestational weeks is not affected by related medical history. For high-risk patients, laparoscopic cervical cerclage is more effective than vaginal cervical cerclage in preventing extremely preterm 28 weeks ago, premature delivery 34 weeks ago and preterm delivery 37 weeks ago. Therefore, laparoscopic cervical cerclage is preferred for patients with high-risk medical history. However, laparoscopic cervical cerclage significantly increases the cesarean section rate, and the advantages and disadvantages of retaining laparoscopic cervical cerclage in situ still need further follow-up and research.

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“…К ним относятся сбалансированное питание, контроль веса, прекращение курения, употребления алкоголя, а также лечение инфекций, передающихся половым путем, у обоих супругов [9][10][11][12][13][14][15]. Все это также может оптимизировать фертильность, повышая тем самым вероятность естественного зачатия [8,10,[12][13][14][15][16][17][18].…”

Section: Discussionunclassified

“…Увеличение возраста женщин, реализующих репродуктивную функцию, накопление патологических состояний гинекологической сферы и соматических заболеваний, необходимость использования вспомогательных репродуктивных технологий определяют портрет пациента, обращающегося за рекомендациями о планировании беременности [3,8,10,11]. Однако если для условно здоровых женщин минимальный рекомендованный объем обследования определен и валидизирован, то у пациентов с невынашиванием беременности и ИЦН объем медицинской помощи разнообразен, неоднороден и дискутабелен [17][18][19][20]. Понимание особенностей течения беременности у женщин с ИЦН, которая имеет связь с невынашиванием беременности, позволит оказывать медицинскую помощь персонализированно, учитывая индивидуальные особенности анамнеза, на основе принципов доказательной медицины, представленных в национальном клиническом протоколе и международных руководствах [21][22][23][24][25].…”

Section: Discussionunclassified

Rehabilitation of Reproductive Function in Patients with Miscarriage and Cervical Insufficiency in History

Мицкевич¹,

Дивакова²

2022

Репродуктивное Здоровье. Восточная Европа

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Цель. Определить объем, эффективность медицинской диагностики и помощи для реабилитации репродуктивной функции и прегравидарной подготовки у пациентов с самопроизвольным выкидышем на фоне истмико-цервикальной недостаточности. Материалы и методы. В исследование были включены 294 женщины. Основную группу составил 91 пациент с самопроизвольным выкидышем на фоне ИЦН, группу сравнения – 103 пациента со срочными родами на фоне ИЦН, контрольную группу – 100 женщин со срочными родами без ИЦН. Изучены анамнестические данные, особенности течения настоящей беременности, результаты лабораторных и инструментальных методов исследования. Выполнена оценка влияния изученных факторов на сроки завершения беременности. Статистический анализ полученных данных выполнен при помощи компьютерных программ Microsoft Excel (из пакета Microsoft Office 2016) и STATISTICA (версия 12.0). Результаты. Немодифицируемыми факторами риска самопроизвольного выкидыша на фоне ИЦН являются: ИЦН в анамнезе, самопроизвольный выкидыш в позднем сроке в анамнезе, преждевременные роды в анамнезе; высокий паритет родов; повторные медицинские аборты и вакуум-аспирации; хирургические вмешательства с расширением цервикального канала; НДСТ средней и тяжелой степени. Модифицируемыми факторами риска, в отношении которых можно выполнить первичную и вторичную профилактику невынашивания у пациентов с ИЦН, оказались: интергенетический интервал менее 1 года; врожденные аномалии развития матки; гиперпролактинемия; нарушения менструального цикла; никотиновая зависимость; дисплазия шейки матки во время настоящей беременности; бессимптомная бактериурия во время настоящей беременности. Использование ПК с 0,15 мг дезогестрела и 0,03 мг этинилэстрадиола в течение 12 месяцев позволяет снизить риск самопроизвольного выкидыша в 2 раза, выполнить диагностические и лечебные процедуры для реабилитации репродуктивной функции при наличии высокой приверженности и профиле безопасности в 79,2% случаев. Персонифицированная программа реабилитации репродуктивной функции и преконцептивной подготовки у пациентов с самопроизвольным выкидышем на фоне ИЦН в анамнезе, включающая интергенетический интервал не менее 12 месяцев, коррекцию врожденных аномалий развития матки, нарушений менструального цикла, санацию хронических очагов инфекции, донацию микроэлементов и витаминов согласно индивидуальным потребностям, позволяет снизить невынашивание беременности на 19,0% и повысить число срочных родов на 26,7%. Заключение. Прогнозирование особенностей гестации у пациентов с невынашиванием беременности и ИЦН в анамнезе, выбор оптимального объема оказания медицинской диагностики и помощи во время интергенетического интервала и на этапе прегравидарной подготовки будут способствовать снижению репродуктивных потерь. The aim. To determine the structure and effectiveness of medical diagnostics and care for the rehabilitation of reproductive function and preconception in patients with miscarriage and cervical insufficiency in history. Materials and methods. The study included 294 women. The main group consisted of 91 patients with miscarriage and cervical insufficiency in history, the comparison group – 103 patients with term delivery and cervical insufficiency in history, the control group – 100 women with term delivery cervical insufficiency. The anamnestic data, features of the current pregnancy, the results of laboratory and instrumental research methods were studied. The impact of the studied factors on the timing of the completion of pregnancy was assessed. Statistical analysis of the obtained data was carried out using computer programs Microsoft Excel (from the Microsoft Office 2016 package) and STATISTICA (version 12.0). Results. Non-modifiable risk factors for miscarriage and cervical insufficiency in history are: history of cervical insufficiency, history of miscarriage in the second trimester, history of premature birth; high parity of childbirth; repeated medical abortions and vacuum aspirations; surgical interventions with the expansion of the cervical canal; moderate and severe degree of undifferentiated connective tissue dysplasia. Modifiable risk factors for which it is possible to perform primary and secondary prevention of miscarriage in patients with cervical insufficiency were: intergenetic interval less than 1 year; congenital anomalies in the development of the uterus; hyperprolactinemia; menstrual irregularities; nicotine addiction; cervical dysplasia during present pregnancy; asymptomatic bacteriuria during present pregnancy. The use of oral contraceptive with 0.15 mg of desogestrel and 0.03 mg of ethinyl estradiol for 12 months can reduce the risk of miscarriage by 2 times, perform diagnostic and therapeutic procedures for the rehabilitation of reproductive function with high adherence and a safety profile in 79.2% of cases. A personalized program for the rehabilitation of reproductive function and preconception in patients with miscarriage against the background of cervical insufficiency in history, including an intergenetic interval of at least 12 months, correction of congenital anomalies in the development of the uterus, menstrual disorders, sanitation of chronic foci of infection, donation of microelements and vitamins according to individual needs, allows to reduce miscarriage by 19.0% and increase the number of term deliveries by 26.7%. Conclusion. Predicting the features of gestation in patients with miscarriage and a history of cervical insufficiency, choosing the optimal structure of medical diagnostics and care during the intergenetic interval and at the stage of preconception preparation will help reduce reproductive losses.

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The association of chronic endometritis with mid-trimester loss due to cervical incompetence and the outcome of laparoscopic cervical cerclage

Cited by 4 publications

References 20 publications

Effect of different surgical routes on pregnancy outcome of history-indicated cervical cerclage

Effect of different surgical routes on pregnancy outcome of history-indicated cervical cerclage

Effect of different surgical routes on pregnancy outcome of history-indicated cervical cerclage

Rehabilitation of Reproductive Function in Patients with Miscarriage and Cervical Insufficiency in History

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