THE EFFICACY OF OBSTETRIC PESSARIES IN MULTIPLE PREGNANCY DEPENDING ON THE LENGTH OF CERVIX

  • A. Sukharev Medical Institute of Sumy State University, Sumy, Ukraine
  • T. Kopitsa Medical Institute of Sumy State University, Sumy, Ukraine
Keywords: multiple pregnancy, miscarriage, pessarium

Abstract

The study was conducted in the city maternity hospital of Sumy (Ukraine) at the Department of obstetrics and gynecology of Sumy State University. Information was collected by interviewing and examining pregnant women using special research methods. In addition, the medical records of children born from multiple pregnancies were analyzed. All pregnant women used transvaginal ultrasound scanning.

The aim of our study is to evaluate the effectiveness of pessarium in multiple pregnancy in women with miscarriage risk depending on the length of the cervix.

We used Simurg pessarium (Belarus). The pessaries were applied in 15-17 weeks.

Pregnancy, delivery and perinatal outcomes were analyzed in 45 women with diamnionic dichorionic pregnancy. All pregnant women were divided into 3 groups according to Dunne cervicometry.

20 pregnant women with cervical length of more than 38 mm did not use diaphragm and tocolytic therapy. Pregnancy proceeded without complications and ended with labor in time.

In 13 women with a cervical length of 26-38 mm, pessarium was applied in connection with the threat of miscarriages. Tocolytic therapy was not used. Term labor was observed in 92.3% of cases. The average weight of the fetuses was 2875+375 g.

In 12 women with a cervical length of 16-25 mm pessarium was installed in connection with threatened miscarriages, and tocolytic therapy was used. Spontaneous vaginal delivery was observed in 75.0% of the women. Premature break of amniotic fluid was observed in 40.0%. The average weight of the fetuses was 2750 + 335 g. Newborns had the lowest score at birth.

Comparative analysis helped to conclude that the results of uncomplicated pregnancy gestation and with the obstetric pessarium in women with the cervix length 26-38 mm did not differ significantly.

Based on the findings, practical recommendations are proposed. The recommendations that were made as a result of the study were implemented in the work of the maternity hospital.

The prospect of further research requires further study of the problems of antenatal care in multiple pregnancies, prevention of gestational complications, optimization of labor, prevention of perinatal losses.

References

1. American College of Obstetricians and Gynecologists. ACOG Practice Bulletin No.142:Cerclage for the management of cervicalinsufficiency. Obstet Gynecol. 2014; 123: 372
2. Alfirevic Z, Owen J, Carreras Moratonas E. et al. [Vaginal progesterone, cerclage or cervical pessary for preventing preterm birth inasymptomatic singleton pregnant women with a history of preterm birth and a sonographic short cervix.] Ultrasound Obstet Gynecol. 2013; 41: 146.
3. Conde-Agudelo A, Romero R, Nicolaides K.et al. [Vaginal progesterone vs. cervical cerclage for the prevention of preterm birth in women with a sonographic short cervix,previous preterm birth, and singleton gestation: a systematic review and indirect comparison metaanalysis.] Am J Obstet Gynecol. 2013; 208: 42.e1.
4. Vousden N, Hezelgrave N, Carter J. et al. [Prior ultrasound-indicated cerclage: how should we manage the next pregnancy?] Eur J Obstet Gynecol Reprod Biol. 2015; 188: 129.
5. Levakov SA, Borovkova EI, Sheshukova NA, Borovkov IM. [Management of patients with cervical insufficiency.] Akusherstvo, ginekologiya i reproduktsiya/ Obstetrics, gynecology and reproduction. 2016;(2): 64-69 (in Russian).
6. Bespalova ON, Sargsyan GS. [Pessaries in clinical practice.] Journal of Obstetrics and Women’s Diseases. 2015;(2):97-108.
7. Liem SM, van Baaren GJ, Delemarre FM, et al. [Economic analysis of use of pessary to prevent preterm birth in women with multiple pregnancy (ProTWIN trial).] Ultrasound Obstet Gynecol. 2014;44:338-45.doi:10.1002/uog.13432.
8. Krasnopolskiy VI, Novikov SV, Zharova, AA. [Management of pregnancy and childbirth in multiple pregnancies] Almanac of clinical medicine. 2015;(37) :32–34.
9. Makatsaria NA. [Monochorionic multiple pregnancy] Obstetrics, gynecology and reproduction. 2014;8(2):14–18.
10. Nikitina IM. [Experience of using unloading obstetric pussy in preventing miscarriage in multiple pregnancy] Perinatology and pediatrics. 2017;1(69):51–58.
Published
2020-10-04
How to Cite
A. Sukharev, & T. Kopitsa. (2020). THE EFFICACY OF OBSTETRIC PESSARIES IN MULTIPLE PREGNANCY DEPENDING ON THE LENGTH OF CERVIX. Eastern Ukrainian Medical Journal, 6(4), 382–388. Retrieved from https://eumj.med.sumdu.edu.ua/index.php/journal/article/view/105