Use of a dome-shaped silicone obstetric pessary in pregnant women with placenta previa as a method for prevention of early preterm delivery
Objective. To evaluate the efficiency of using an obstetric pessary in combination of progesterone in a group of pregnant women at high risk for miscarriage and placenta previa.Barinov S.V., Shamina I.V., Lazareva O.V., Tirskaya Yu.I., Dikke G.B., Savelyeva I.V., Ledovskikh I.O., Dudkova G.V., Klementyeva L.L., Atamanenko O.Yu.
Subjects and methods. A total of 217 pregnant women at high risk for preterm delivery with placenta previa were examined. A study group (Group A) consisted of 81 pregnant women, in whom a comprehensive approach with a Dr. Arabin obstetric pessary was used in combination with micronized progesterone; a comparison group (Group B) included 136 patients who received micronized progesterone only. During the investigation, each group was divided into subgroups according to the type of placenta previa: Groups IA1 (n = 13), IB1 (n = 50) with complete placenta previa, Groups IA2 (n = 25), IB2 (n = 37) with incomplete placenta previa and Groups IA3 (n = 43), IB3 (n = 49) with low placentation.
Resu1ts. The highest rate of complications as bleeding was detected in Group B: in 48.6 (18/37) of the patients with incomplete placenta previa during pregnancy and in 80.0% (40/50) of the parturient women with complete placenta previa during labor. Bleeding during pregnancy was three times less frequently seen in the group of patients who used a Dr. Arabin in combination with progesterone than in that receiving progesterone only: 11.1% (9/81) versus 33.1% (45/136), respectively (χ2 = 7.416; p = 0.006). Early premature deliveries occurring at less than 34 weeks’ gestation was 2.7 times less frequently observed in Group A than in Group B (χ2 = 4.678; p = 0.031). Placental migration was diagnosed 1.8 times significantly more often in Group A, mainly in the low-placentation subgroup (χ2 = 4.369; p = 0.037) due to the lower resistance index in the arcuate arteries and to the change in the anterior uterocervical angle.
Conclusion. The combined approach to managing patients with placenta previa at high risk for miscarriage reduces the frequency of early preterm delivery at 34 weeks’ gestation by 2.7 times and the risk of bleeding during labor by 3 times. Placental migration occurs in 48.1% of the pregnant women with placenta previa when a Dr. Arabin obstetric pessary is used.
Keywords
obstetric pessary
preterm delivery
abnormal placental location
placental migration
Supplementary Materials
References
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Received 30.11.2017
Accepted 22.12.2017
About the Authors
Barinov Sergej Vladimirovich, doctor of medical sciences, professor, head of the department of obstetrics and gynecology № 2, Omsk State Medical University.644043, Russia, Omsk, Lenina str. 12. Tel.: +73821240658. E-mail: barinov_omsk@mail.ru
Shamina Inna Vasil’evna, candidate of medical sciences, docent, assistant professor at the department of obstetrics and gynecology № 2, Omsk State Medical University. 644043, Russia, Omsk, Lenina str. 12. Tel.: +73821240658. E-mail: innadocsever@rambler.ru
Lazareva Oksana Vyacheslavovna, candidate of medical science, assistant of the department of obstetrics and gynecology № 2, Omsk State Medical University.
644043, Omsk, Lenin str. 12. Tel.: +73812240658. E-mail: lazow@mail.ru
Tirskaya Yuliya Igorevna, doctor of medical sciences, docent, professor at the department of obstetrics and gynecology № 2, Omsk State Medical University.
644043, Russia, Omsk, Lenina str. 12. Tel.: +73821240658. E-mail: yulia.tirskaya@yandex.ru
Dikke Galina Borisovna, Honored Scientist and Education Worker, MD, Professor of the Department of Obstetrics, Gynecology and Reproductive Medicine,
Faculty of Advanced Training of Medical Workers, Peoples’ Friendship University of Russia. Tel. : +74954345300. E-mail: galadikke@yandex.ru
Savelieva Irina Vyacheslavovna, doctor of medical sciences, head of the department of obstetrics and gynecology № 1, Omsk State Medical University.
644043, Russia, Omsk, Lenina str. 12. Tel.: +73821240658. E-mail: saveljeva_iv_omsk@mail.ru
Ledovskih Inna Olegovna, assistant of the Department of Department of Radiation Diagnostics, doctor of ultrasonic diagnostics of the Department of Reproductive and Perinatal Medicine, Perinatal Center of Regional Clinical Hospital. 644011, Russia, Omsk, Beresovaya str. 3. Tel.: +73812251578. E-mail: innaledo@mail.ru
Dudkova Galina Vladimirovna, doctor obstetrician-gynaecologist, head of the Department of Reproductive and Perinatal Medicine,
Perinatal Center of Regional Clinical Hospital. 644011, Russia, Omsk, Beresovaya str. 3. Tel.: +73812359115. E-mail: ms.dudkova@mail.ru
Klementyeva Lyudmila L., doctor obstetrician-gynaecologist, OOO “Alfa-EmBio”.
644043, Russia, Omsk, Volochayevskaya street, 11-1-30P. Tel.: +73812955563. E-mail: kll_embio@mail.ru
Atamanenko Olga Yurievna, doctor obstetrician-gynaecologist of the Department of Reproductive and Perinatal Medicine, Perinatal Center of Regional Clinical Hospital. 644011, Russia, Omsk, Beresovaya str. 3. Tel.: +73812251578. E-mail: Olechka2108@yandex.ru
For citations: Barinov S.V., Shamina I.V., Lazareva O.V., Tirskaya Yu.I., Dikke G.B., Savelyeva I.V., Ledovskikh I.O., Dudkova G.V., Klementyeva L.L., Atamanenko O.Yu. Use of a dome-shaped silicone obstetric pessary in pregnant women with placenta previa as a method for prevention of early preterm delivery. Akusherstvo i Ginekologiya/Obstetrics and Gynecology. 2018; (1): 54-60. (in Russian)
https://dx.doi.org/10.18565/aig.2018.1.54-60
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