Successful experience with rescue cerclage for critical isthmicocervical insufficiency
Background: Preterm birth (PB) is one of the leading sociomedical problems in obstetrics, despite the ongoing large-scale prevention programs, including those implemented at national and international levels. The prognostic manifestation of spontaneous PB is isthmicocervical insufficiency (ICP) that occurs subclinically in some cases and, when its diagnosis is delayed or its manifestation is late, requires emergency measures that are rescue cerclage (emergency or salvage cerclage).Khodzhaeva Z. S, Gorina K.A., Iurova M. V., Muminova K. T., Oshkhunova M.S., Klimenchenko N.I.
Case report: A pregnant woman with a family obstetric history underwent surgical correction of critical ICI within the borderline period, which in combination with adequately chosen medical therapy and subsequent insertion of an unloading obstetric pessary, as well as carefully monitoring the vaginal microbiota against infections, made it possible to prolong the pregnancy to full term.
Conclusion: The timely diagnosis of ICI makes it possible to implement a whole range of preventive measures in a planned manner after the necessary pre-examination; however, a rescue cerclage can be carried out as the only possible salvage measure aimed at prolonging pregnancy and improving perinatal outcomes in a number of cases due to the clinical scenario, with the surgeon’s sufficient experience and the capabilities of an obstetric hospital.
Keywords
critical ischemicocervical insufficiency
preterm birth
rescue cerclage
microbiological monitoring
perinatal outcomes
References
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Received 01.09.2021
Accepted 20.09.2021
About the Authors
Zulfiya S. Khodzhaeva, Dr. Med. Sci., Professor, Deputy Director for Research of Obstetrics Institute of the Institution (Department of Obstetrics), Academician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Health of the Russian Federation, +7(916)407-75-67, zkhodjaeva@mail.ru, https:// orcid.org/0000-0001-8159-3714, 117997, Russia, Moscow, Ac. Oparin str., 4.Ksenia A. Gorina, Junior Researcher the Department of Pregnancy Pathology, Academician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Health of the Russian Federation, +7(926)649-77-32, k_gorina@oparina4.ru, https://orcid.org/0000-0001-6266-2067, 117997, Russia, Moscow, Ac. Oparin str., 4.
Maria V. Iurova, PhD student of the Department of Obstetrics and Gynecology, Academician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Health of the Russian Federation, +7(499)248-05-53, m_yurova@oparina4.ru, https://orcid.org/0000-0002-0179-7635, 117997, Russia, Moscow, Ac. Oparin str., 4.
Kamilla T. Muminova, PhD, Junior Researcher the Department of Pregnancy Pathology, Academician V.I. Kulakov National Medical Research Center for Obstetrics,
Gynecology and Perinatology, Ministry of Health of the Russian Federation, +7(916)373-77-07, k_muminova@oparina4.ru, https:// orcid.org/0000-0003-2708-4366, 117997, Russia, Moscow, Ac. Oparin str., 4.
Madina S. Oshkhunova, PhD student, Academician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Health of the Russian Federation, +7(916)407-75-67, m_ashunova@oparina4.ru, https://orcid.org/0000-0002-7044-7962, 117997, Russia, Moscow, Ac. Oparin str., 4.
Nataly I. Klimenchenko, PhD, Senior Researcher the Department of Pregnancy Pathology, Academician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Health of the Russian Federation, +7(903)756-45-72, n_klimenchenko@oparina4.ru, https://orcid.org/0000-0002-9901-225X, 117997, Russia, Moscow, Ac. Oparin str., 4.
Authors’ contributions: Khodzhaeva Z.S., Gorina K.A., lurova M.V., Muminova K.T., Oshkhunova M.S., Klimenchenko N.I. - development of the design of the investigation; obtaining data for analysis; reviewing publications on the topic of the article; analysis of the findings; writing the text of the manuscript.
Conflicts of interest: The authors declare that there are no possible conflicts of interest.
Funding: The investigation has not been sponsored.
Patient Consent for Publication: The patient has signed an informed consent form to publish her data.
For citation: Khodzhaeva Z. S, Gorina K.A., Iurova M. V., Muminova K. T., Oshkhunova M.S., Klimenchenko N.I. Successful experience with rescue cerclage for critical isthmicocervical insufficiency. Akusherstvo i Ginekologiya/Obstetrics and Gynecology. 2022; 1:153-157 (in Russian)
https://dx.doi.org/10.18565/aig.2022.1.153-157
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