HEALTH OF WOMAN. 2016.9(115):117–122 
 

The role of cervical cerclage and vaginal progesterone in the treatment of cervical incompetence without a history of premature labor

Shao-Wei Wang, Lin-Lin Ma, Shuai Huang, Lin Liang, Jun-Rong Zhang

Department of Obstetrics and Gynecology, Beijing Hospital, National Centerof Gerontology, Beijing 100730, China

Chinese Medical Journal November 20, 2016 Volume 129 Issue 22

Premature labor (PL) is the main cause of perinatal morbidity and mortality worldwide, and their prevention is an important health care priority. Isthmic-cervical insufficiency (ICIN) is a well-known risk factor PL, the frequency of which is about 0.1-2.0 percent. At the same time, optimal treatment is absent for today. ICIN is responsible for about 15% of all usual loss of pregnancy in the period of 16-28 weeks of gestation.

The aim of the research: to evaluation of efficacy and safety cervical cerclage and vaginal progesterone in the treatment of ICIN with and without a history of PL.

Materials and methods. It was a retrospective analysis of outcomes of pregnancy in 198 patients with diagnosed ICIN from January 2010 until October 2015 in Beijing hospital. From the 198 women the 116 patients who had at least one PL until 32 weeks or an abortion in the II trimester in connection with ICIN, were assigned to the group with the history of PL, the others were assigned to the group without a history of PL. Patients were performed the cerclage (group of cerclage) or were prescribed vaginal progesterone (group of vaginal progesterone) prior to delivery. Evaluated the differences in the gestation period during labor, the frequency of the PL, neonatal consequences, complications and method of delivery between the two treatment groups.

Results. The final analysis included 198 patients with ICIN, of these, 116 patients had a PL in history and 80 patients without a history of PR. In comparison with the history of PL, the patient from the cerclage group had a much greater length of the cervix in 2 weeks after starting of the treatment (23.1±4.6 mm against 12.4±9.1 mm; P=0.002), greater number of births at term 37 weeks (63.4% versus 33.3%; P=0.008), higher average body weight of children at birth (2860 g vs 2250 g; P=0.031) and a smaller part of the newborn on a scale Apgar in the first minute of less than 7 points (5.9 percent versus 33.3%; P=0.005) in comparison with patients from group of vaginal progesterone. No significant differences were found in other outcomes between the two groups. In the group without a history of PR there were no significant differences in maternal cases between group of cerclage and group of vaginal progesterone, such as the median gestational period at the time of birth (37.4 37.3 weeks vs weeks; P=0.346) and the number of births at term 37 weeks (55.9% vs 60.9%; P=0.569). Also there were no significant differences in neonatal cases between the groups, including the average body weight of children at birth (2.750 g vs. 2810 g; P=0.145), perinatal mortality (5.9% vs 6.5%; P=0.908) and also the point according to Apgar scale (8.8% vs 8.7%; P=0.984).

Conclusion. Application of cerclage proved more advantages in maternal and neonatal cases than the vaginal progesterone, in women`s with isthmic-cervical insufficiency (ICIN) and a previous history of premature labor (PL) therapy has asymptomatic process, while the use of cerclage and vaginal progesterone showed the same efficacy in women with asymptomatic ICIN, but without the history of PL.

Key words: cervical cerclage, isthmic-cervical insufficiency, premature labor, vaginal progesterone.

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