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PROGNOSTIC CHARACTERISTICS OF CERVICAL INSUFFICIENCY IN
PREGNANT WOMEN
Tilavova G.Y.
Tashkent Medical Academy, Tashkent, Uzbekistan
https://doi.org/10.5281/zenodo.15343859
Relevance.
The problem of cervical incompetence is becoming increasingly
relevant, not only from a medical and biological perspective but also due to its
social and economic importance. Preterm infants account for 70% of perinatal
deaths and 65-75% of infant mortality. The rates of infant mortality are 8-13
times higher in preterm births compared to term births. According to data, the
frequency of cervical incompetence ranges from 0.2% to 2%, accounting for 8-
9% of all preterm births. Cervical cerclage is accepted as an effective
intervention for pregnancies where a history of previous pregnancy loss or
extreme premature delivery indicates a risk of cervical insufficiency.
Research Objective:
To study the prognostic criteria for pregnancy
outcomes in cases of cervical incompetence, improve diagnostic effectiveness,
and enhance forecasting capabilities to prevent complications.
Materials and Methods:
The study involved 20 women who underwent
cervical cerclage (main group), 15 pregnant women identified with a risk of
preterm birth without cervical incompetence (comparison group), and 15
healthy pregnant women (control group). Their anamnesis, medical-social data,
instrumental, and laboratory indicators were collected and analyzed
comparatively.
Results:
In the main group, 45% of the women underwent surgical
cerclage, while 55% received hormonal therapy. Their reproductive age
distribution was as follows: early reproductive age – 2%, optimal reproductive
age – 50%, and late reproductive age – 46%. Additionally, upon studying their
anamnesis, it was found that 6 women (30%) had their first pregnancy, 8
women (40%) had a second pregnancy, and 6 women (30%) had multiple
pregnancies (4 or more). Among those who received prophylactic cerclage, one
woman had a complex medical history and underwent the procedure during the
12-15 weeks of pregnancy. Six women had cerclage performed between the 16th
and 20th weeks of pregnancy.
In two other cases, emergency cerclage was performed between the 20th
and 24th weeks due to a sharp decrease in cervical length and the risk of
amniotic membrane rupture. For hormonal therapy, 11 women were selected.
Their age distribution was: early reproductive age – 27.27%, optimal
reproductive age – 36.36%, and late reproductive age – 36.36%. Among these
women, 5 (45.45%) had their first pregnancy, 4 (36.36%) had a second
pregnancy, and 2 (18.18%) had multiple pregnancies (4 or more). Of these
women, 36.36% received vaginal progesterone, while 63.63% received it orally.
According to the study results, among the women who underwent cerclage,
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66.67% delivered after the 38th week, while 22.22% delivered between the
36th and 37th weeks. In 11.11% of cases, the pregnancy ended prematurely
without reaching term.
In the progesterone therapy group, delivery occurred between the 36th and
37th weeks in 27.27% of cases, while in 63.63%, it occurred after the 37th week.
In 9% of cases, delivery occurred before term.
In the comparison group, cervical incompetence was identified as the cause
of miscarriage in 26.67% due to hormonal changes, in 20% due to uterine
anomalies (such as fibroids or polyps), in 40% due to various infections, and in
13.33% due to late reproductive age (over 40 years).
While the two groups' associations with cervical operations were
comparable in magnitude, nulliparous women's associations with prior
miscarriages were significantly larger, particularly in multi-fetal gestations. In
contrast, the independent connection between ICI and the history of prior losses
was similar in singleton and multifetal pregnancies, and the association between
ICI and multi-fetal gestation was significantly smaller for parous women, when
further adjustments were made for characteristics associated to prior births.
Conclusions:
The study results indicate that performing cerclage between
the 16th and 20th weeks of pregnancy significantly increases the likelihood of
carrying the pregnancy to at least the 37th week when cervical incompetence is
diagnosed. It was found that vaginal administration of progesterone is 45%
more effective than oral administration. The risk of miscarriage without cervical
incompetence is primarily associated with hormonal changes and infections in
the genital area.
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