Correction of isthmic-cervical insufficiency in multiple pregnancies: Debating points
Objective. To evaluate the efficiency of a cervical pessary and cerclage and to identify criteria for their application in multiple pregnancy.Dobrokhotova Yu.E., Kuznetsov P.A., Dzhokhadze L.S., Konstantinova K.I.
Material and methods. A search was conducted in the PubMed database and in Russian-language peer-reviewed journals over the last 15 years.
Results. Procedures reducing the frequency of preterm birth in multiple pregnancies were analyzed.
Conclusion. Multiple pregnancy does not always call for the use of a pessary or suturing. Cervical sutures are unambiguously indicated when the length of the cervix is less than 15 mm at 22 weeks’ gestation; it is also worth considering the possibility of using cerclage when the cervical length is 15–25 mm. Cervical pessary placement is justified in women with a cervical length of less than 25 mm before 30 weeks of gestation.
Keywords
premature birth
multiple pregnancy
obstetric pessary
cerclage
Supplementary Materials
- Fig 1. The rate of preterm and multiple birth in Russia (Federal State Statistics, 2015)
- Fig 2. Percentage of multiple birth
References
1. Козлов П.В., Иванников Н.Ю., Кузнецов П.А., Богаева И.И. Эпидемиология, этиология и патогенез поздних преждевременных родов. Акушерство, гинекология и репродукция. 2015; 9(1): 68-76. [Kozlov P.V., Ivannikov N.Yu., Kuznetsov P.A., Bogaeva I.I. Epidemiology, etiology and pathogenesis of late premature births. Akusherstvo, ginekologiya i reproduktsiya. 2015; 9(1): 68-76. (in Russian)]
2. Доброхотова Ю.Э., Ван А.В., Куликова А.С. Перспективы современной токолитической терапии в комплексном лечении угрожающих преждевременных родов (обзор литературы). Акушерство, гинекология и репродукция. 2013; 7(4): 25-31. [Dobrokhotova Yu.E., Van A.V., Kulikova A.S. Prospects of modern tocolytic therapy in the complex treatment of menacing preterm labor (literature review). Akusherstvo, ginekologiya i reproduktsiya. 2013; 7 (4): 25-31. (in Russian)]
3. Федеральная служба государственной статистики. Демографический ежегодник России 2015. Статистический сборник. М.: Росстат; 2015. Доступно по: http://www.gks.ru/bgd/regl/B15_16/Main.htm [Federal Service of State Statistics. Demographic Yearbook of Russia 2015. Statistical compilation. Moscow: Rosstat; 2015. Available at: http://www.gks.ru/bgd/regl/B15_16/Main.htm (in Russian)]
4. Баранов И.И., Токова З.З., Тадевосян А.А. Перинатальные исходы при многоплодных родах. Акушерство и гинекология. 2012; 1: 98-102. [Baranov I.I., Tokova Z.Z., Tadevosyan A.A. Perinatal outcomes of multiple births. Akusherstvo i Ginekologiya/Obstetrics and Gynecology. 2012; (1): 98-102. (in Russian)]
5. Stock S., Norman J. Preterm and term labour in multiple pregnancies. Semin. Fetal Neonatal Med. 2010; 15(6): 336-41. doi: 10.1016/j.siny.2010.06.006.
6. Александрова Н.В., Баев О.Р., Иванец Т.Ю. Преждевременные роды при беременности, наступившей с использованием вспомогательных репродуктивных технологий. Пути профилактики. Акушерство и гинекология. 2012; 4-2: 33-8. [Aleksandrova N.V, Bayev O.R,. Ivanets T.Yu . Premature birth in assisted reproductive technology pregnancy: ways of prevention. Akusherstvo i Ginekologiya/Obstetrics and Gynecology. 2012; (4-2): 33-8. (in Russian)]
7. Кузнецов П.А. ВРТ: эра оптимизации. Этические основы и новая нормативная база репродуктивной медицины. Status Praesens. Гинекология, акушерство, бесплодный брак. 2013; 4: 74. [Kuznetsov P.A. ART: the era of optimization. Ethical foundations and a new regulatory framework for reproductive medicine. Status Praesens. Ginekologiya, akusherstvo, besplodnyiy brak. 2013; 4: 74. (in Russian)]
8. Krampl E., Klein K. Prematurity in multiple pregnancies. Gynakol. Geburtshilfliche Rundsch. 2007; 47(2): 64-9.
9. Макаров О.В., Козлов П.В., Дуленков А.Б., Такташова Р.Н., Воронцова Ю.Н. Пути профилактики перинатальной заболеваемости и смертности при недоношенной беременности. Вестник Российского государственного медицинского университета. 2009; 4: 70-5. [Makarov O.V., Kozlov P.V., Dulenkov A.B., Taktashova R.N., Vorontsova Yu.N. Ways of preventing perinatal morbidity and mortality in preterm pregnancy. Vestnik Rossiyskogo gosudarstvennogo meditsinskogo universiteta. 2009; 4: 70-5. (in Russian)]
10. Доброхотова Ю.Э., Джохадзе Л.С., Копылова Ю.В. Возможности терапии угрозы преждевременных родов. Гинекология. 2016; 18(1): 68-70. [Dobrohotova Yu.E., Dzhohadze L.S., Kopyilova Yu.V. The possibilities of treating the threat of premature delivery. Ginekologiya. 2016; 18(1): 68-70. (in Russian)]
11. Rode L., Tabor A. Prevention of preterm delivery in twin pregnancy. Best Pract. Res. Clin. Obstet. Gynaecol. 2014; 28(2): 273-83. doi: 10.1016/j.bpobgyn.2013.11.002.
12. Доброхотова Ю.Э., Степанян А.В., Шустова В.Б., Дикке Г.Б. Истмико-цервикальная недостаточность: современная базовая терапия. Фарматека. 2015; 3: 38-43. [Dobrokhotova Yu.E., Stepanyan A.V., Shustova V.B., Dicke G.B. Isthmiko-cervical insufficiency: modern basic therapy. Farmateka. 2015; 3: 38-43. (in Russian)]
13. Brubaker S.G., Gyamfi C. Prediction and prevention of spontaneous preterm birth in twin gestations. Semin. Perinatol. 2012; 36(3): 190-4. doi: 10.1053/j.semperi.2012.02.003.
14. Fuchs F., Senat M.V. Multiple gestations and preterm birth. Semin. Fetal Neonatal Med. 2016; 21(2): 113-20. doi: 10.1016/j.siny.2015.12.010.
15. Fox N.S., Rebarber A., Roman A.S., Klauser C.K., Saltzman D.H. Association between second-trimester cervical length and spontaneous preterm birth in twin pregnancies. J. Ultrasound Med. 2010; 29(12): 1733-9.
16. Gordon M.C., McKenna D.S., Stewart T.L., Howard B.C., Foster K.F., Higby K. et al. Transvaginal cervical length scans to prevent prematurity in twins: a randomized controlled trial. Am. J. Obstet. Gynecol. 2016; 214(2): 277.e1-7. doi: 10.1016/j.ajog.2015.08.065.
17. Berghella V., Szychowski J.M., Owen J., Hankins G., Iams J.D., Sheffield J.S. et al. Vaginal Ultrasound Trial Consortium. Suture type and ultrasound-indicated cerclage efficacy. J. Matern. Fetal Neonatal Med. 2012; 25(11): 2287-90. doi: 10.3109/14767058.2012.688081.
18. Park J.M., Tuuli M.G., Wong M., Carbone J.F., Ismail M., Macones G.A. et al. Cervical cerclage: one stitch or two? Am. J. Perinatol. 2012; 29(6): 477-81. doi: 10.1055/s-0032-1304831.
19. Israfil-Bayli F., Toozs-Hobson P., Lees C., Slack M., Ismail K. Cerclage outcome by the type of suture material (COTS): study protocol for a pilot and feasibility randomised controlled trial. Trials. 2014; 15: 415. doi: 10.1186/1745-6215-15-415.
20. Rafael T.J., Berghella V., Alfirevic Z. Cervical stitch (cerclage) for preventing preterm birth in multiple pregnancy. Cochrane Database Syst. Rev. 2014; (9): CD009166. doi: 10.1002/14651858.CD009166.pub2.
21. Roman A., Rochelson B., Martinelli P., Saccone G., Harris K., Zork N. et al. Cerclage in twin pregnancy with dilated cervix between 16 to 24 weeks of gestation: retrospective cohort study. Am. J. Obstet. Gynecol. 2016; 215(1): 98. e1-98. e11. doi: 10.1016/j.ajog.2016.01.172.
22. Roman A., Rochelson B., Fox N.S., Hoffman M., Berghella V., Patel V. et al. Efficacy of ultrasound-indicated cerclage in twin pregnancies. Am. J. Obstet. Gynecol. 2015; 212(6): 788. e1-6. doi: 10.1016/j.ajog.2015.01.031.
23. Friedman A.M., Ananth C.V., Siddiq Z., DʼAlton M.E., Wright J.D. Trends and predictors of cerclage use in the United States from 2005 to 2012. Obstet. Gynecol. 2015; 126(2): 243-9. doi: 10.1097/AOG.0000000000000930.
24. Baker E., Hunter T., Okun N., Farine D. Current practices in the prediction and prevention of preterm birth in patients with higher-order multiple gestations. Am. J. Obstet. Gynecol. 2015; 212(5): 671. e1-7. doi: 10.1016/j.ajog.2014.12.031.
25. Abdel-Aleem H., Shaaban O.M., Abdel-Aleem M.A. Cervical pessary for preventing preterm birth. Cochrane Database Syst. Rev. 2013; (5): CD007873. doi: 10.1002/14651858.CD007873.pub3.
26. Liem S., Schuit E., Hegeman M., Bais J., de Boer K., Bloemenkamp K. et al. Cervical pessaries for prevention of preterm birth in women with a multiple pregnancy (ProTWIN): a multicentre, open-label randomised controlled trial. Lancet. 2013; 382(9901): 1341-9. doi: 10.1016/S0140-6736(13)61408-7.
27. Liem S.M., van Baaren G.J., Delemarre F.M., Evers I.M., Kleiverda G., van Loon A.J. et al. Economic analysis of use of pessary to prevent preterm birth in women with multiple pregnancy (ProTWIN trial). Ultrasound Obstet. Gynecol. 2014; 44(3): 338-45. doi: 10.1002/uog.13432.
28. Tajik P., Monfrance M., van ‘t Hooft J., Liem S.M., Schuit E., Bloemenkamp K.W. et al. A multivariable model to guide the decision for pessary placement to prevent preterm birth in women with a multiple pregnancy: a secondary analysis of the ProTWIN trial. Ultrasound Obstet. Gynecol. 2016; 48(1): 48-55. doi: 10.1002/uog.15855.
29. Liem S.M., Schuit E., van Pampus M.G., van Melick M., Monfrance M., Langenveld J. et al. Cervical pessaries to prevent preterm birth in women with a multiple pregnancy: a per-protocol analysis of a randomized clinical trial. Acta Obstet. Gynecol. Scand. 2016; 95(4): 444-51. doi: 10.1111/aogs.12849.
30. Di Tommaso M., Seravalli V., Arduino S., Bossotti C., Sisti G., Todros T. Arabin cervical pessary to prevent preterm birth in twin pregnancies with short cervix. J. Obstet. Gynaecol. 2016; 36(6): 715-8.
31. Monfrance M.J., Schuit E., Groenwold R.H., Oudijk M.A., de Graaf I.M., Bax C.J. et al. Pessary placement in the prevention of preterm birth in multiple pregnancies: a propensity score analysis. Eur. J. Obstet. Gynecol. Reprod. Biol. 2016; 197: 72-7. doi: 10.1016/j.ejogrb.2015.11.001.
Received 03.02.2017
Accepted 17.02.2017
About the Authors
Yu.E. Dobrokhotova, MD, professor, Head of the Department of Obstetrics and Gynecology, Therapeutic faculty, Pirogov Russian National Research Medical University. 117437, Russia, Moscow, Ostrovityanova str. 1. Tel.: +74955369270. E-mail: pr.dobrohotova@mail.ru. SPIN-код: 2925-9948. AuthorID: 312767P.A. Kuznetsov, PhD, Department of Obstetrics and Gynecology, Therapeutic faculty, Pirogov Russian National Research Medical University.
117437, Russia, Moscow, Ostrovityanova str. 1. Tel.: +74956134509. E-mail: poohsmith@mail.ru. Orcid.org/0000-0003-2492-3910. SPIN-код: 6683-4300. AuthorID: 661796
L.S. Dzhokhadze, PhD, Department of Obstetrics and Gynecology, Therapeutic faculty, Pirogov Russian National Research Medical University.
117437, Russia, Moscow, Ostrovityanova str. 1. Tel.: +74956134509. E-mail: anton-b1@mail.ru. SPIN-код: 3482-8630. AuthorID: 802877
K.I. Konstantinova, intern of the Department of Obstetrics and Gynecology, Medical Faculty, Pirogov Russian National Research Medical University.
117437, Russia, Moscow, Ostrovityanova str. 1. Tel.: +74952374033. E-mail: ksenita14@mail.ru
For citations: Dobrokhotova Yu.E., Kuznetsov P.A., Dzhokhadze L.S., Konstantinova K.I. Correction of isthmic-cervical insufficiency in multiple pregnancies: Debating points. Akusherstvo i Ginekologiya/Obstetrics and Gynecology. 2017; (11): 10-5. (in Russian)
https://dx.doi.org/10.18565/aig.2017.11.10-15
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