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

S V Barinov; N V Artymuk; O N Novikova; I V Shamina; Y I Tirskaya; A A Belinina; O V Lazareva; T V Kadcyna; A V Borisova; S S Stepanov; G C Di Renzo

doi:10.1080/14767058.2019.1656195

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

J Matern Fetal Neonatal Med. 2021 Jul;34(13):2071-2079. doi: 10.1080/14767058.2019.1656195. Epub 2019 Sep 3.

Authors

S V Barinov¹, N V Artymuk², O N Novikova², I V Shamina¹, Y I Tirskaya¹, A A Belinina³, O V Lazareva¹, T V Kadcyna¹, A V Borisova^{1

4}, S S Stepanov¹, G C Di Renzo⁵

Affiliations

¹ 2nd Department of Obstetrics and Gynaecology, Omsk State Medical University, Omsk, Russia.
² Department of Obstetrics and Gynecology named after Professor G.A. Ushakova, Kemerovo State Medical University, Kemerovo, Russia.
³ Altai State Clinical Perinatal Centre, Barnaul, Russia.
⁴ Peoples Friendship University of Russia (RUDN) Moscow, Russian Federation.
⁵ Department of Obstetrics and Gynecology and Centre for Reproductive and Perinatal Medicine, The University of Perugia, Perugia, Italy.

PMID: 31409178
DOI: 10.1080/14767058.2019.1656195

Abstract

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.

Keywords: Cervical incompetence; circular cervical cerclage; obstetric hemorrhage; obstetric pessary; placenta previa; preterm birth.

MeSH terms

Case-Control Studies
Cerclage, Cervical*
Female
Humans
Infant, Newborn
Placenta
Pregnancy
Pregnant Women
Premature Birth* / epidemiology
Premature Birth* / etiology
Premature Birth* / prevention & control
Retrospective Studies
Risk Factors
Uterine Cervical Incompetence* / epidemiology
Uterine Cervical Incompetence* / surgery