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Analysis of risk factors and predictors of pregnancy loss and strategies for the management of cervical insufficiency in pregnant women at a high risk of preterm birth.
Barinov, S V; Artymuk, N V; Novikova, O N; Shamina, I V; Tirskaya, Y I; Belinina, A A; Lazareva, O V; Kadcyna, T V; Borisova, A V; Stepanov, S S; Di Renzo, G C.
Afiliación
  • Barinov SV; 2nd Department of Obstetrics and Gynaecology, Omsk State Medical University, Omsk, Russia.
  • Artymuk NV; Department of Obstetrics and Gynecology named after Professor G.A. Ushakova, Kemerovo State Medical University, Kemerovo, Russia.
  • Novikova ON; Department of Obstetrics and Gynecology named after Professor G.A. Ushakova, Kemerovo State Medical University, Kemerovo, Russia.
  • Shamina IV; 2nd Department of Obstetrics and Gynaecology, Omsk State Medical University, Omsk, Russia.
  • Tirskaya YI; 2nd Department of Obstetrics and Gynaecology, Omsk State Medical University, Omsk, Russia.
  • Belinina AA; Altai State Clinical Perinatal Centre, Barnaul, Russia.
  • Lazareva OV; 2nd Department of Obstetrics and Gynaecology, Omsk State Medical University, Omsk, Russia.
  • Kadcyna TV; 2nd Department of Obstetrics and Gynaecology, Omsk State Medical University, Omsk, Russia.
  • Borisova AV; 2nd Department of Obstetrics and Gynaecology, Omsk State Medical University, Omsk, Russia.
  • Stepanov SS; Peoples Friendship University of Russia (RUDN) Moscow, Russian Federation.
  • Di Renzo GC; 2nd Department of Obstetrics and Gynaecology, Omsk State Medical University, Omsk, Russia.
J Matern Fetal Neonatal Med ; 34(13): 2071-2079, 2021 Jul.
Article en En | MEDLINE | ID: mdl-31409178
AIM: To identify risk factors and predictors of pregnancy loss and to compare the efficacy of Arabin's pessary with cervical cerclage in women at a high risk of pregnancy loss. MATERIALS AND METHODS: This was a two-center retrospective case-control study that included 240 women at a high risk of preterm delivery. Group I (n = 161) included women who underwent insertion of the Arabin's pessary between 14 and 24 weeks of pregnancy. Group II (n = 79) included women who had undergone circular cervical cerclage during the current pregnancy. All women included in the study received micronized vaginal progesterone at the dose of 200 mg/day until and including 34 weeks of gestation. RESULTS: Threatened pregnancy loss defined as spotting or vaginal bleeding in the first trimester was diagnosed in 29.8% (48/161) of patients in Group I versus 37.9% in Group II (p = .448). Postpartum bleeding occurred in 8.1% (13/161) in women in Group I versus 22.8% in Group II (χ2 = 6.500; p = .011). Our study showed that cervical cerclage was most suitable for patients with history of obstetric complications, cervical length <15 mm, and large isthmic uterine fibroids. The use of the Arabin's pessary reduced the rate of preterm births by 1.7-fold. A cluster analysis demonstrated that predictors of preterm birth in women with a high risk of pregnancy loss included: threatened pregnancy loss associated with chorionic/placental abruption, cervical incompetence, uterine fibroid growth to a large size, history of multiple spontaneous pregnancy losses, cervical tears during past labor, and gestational diabetes diagnosed for the first time during the current pregnancy. CONCLUSIONS: Women with a high risk of pregnancy loss treated with Arabin's pessary or cerclage plus vaginal progesterone had a term delivery rate of 70.4% (169/240). The combined strategy of pregnancy management allowed to markedly reduce the number of preterm births.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Incompetencia del Cuello del Útero / Cerclaje Cervical / Nacimiento Prematuro Tipo de estudio: Etiology_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Límite: Female / Humans / Newborn / Pregnancy Idioma: En Revista: J Matern Fetal Neonatal Med Asunto de la revista: OBSTETRICIA / PERINATOLOGIA Año: 2021 Tipo del documento: Article País de afiliación: Rusia Pais de publicación: Reino Unido
Texto completo
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Incompetencia del Cuello del Útero / Cerclaje Cervical / Nacimiento Prematuro Tipo de estudio: Etiology_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Límite: Female / Humans / Newborn / Pregnancy Idioma: En Revista: J Matern Fetal Neonatal Med Asunto de la revista: OBSTETRICIA / PERINATOLOGIA Año: 2021 Tipo del documento: Article País de afiliación: Rusia Pais de publicación: Reino Unido