Please use this identifier to cite or link to this item:
10.3390/medicina59040653
Title: | Management of Pregnancy with Cervical Shortening: Real-Life Clinical Challenges |
Authors: | Kornete, Anna Voložonoka, Ludmila Zolovs, Maksims Rota, Adele Kempa, Inga Gailīte, Linda Rezeberga, Dace Miskova, Anna Department of Obstetrics and Gynaecology Scientific Laboratory of Molecular Genetics Statistics Unit |
Keywords: | preterm birth;short cervix;cervical insufficiency;progesterone;intra-amniotic infection;uterine cervix;pessary;cerclage;3.2 Clinical medicine;1.1. Scientific article indexed in Web of Science and/or Scopus database;SDG 3 - Good Health and Well-being |
Issue Date: | 26-Mar-2023 |
Citation: | Kornete , A , Voložonoka , L , Zolovs , M , Rota , A , Kempa , I , Gailīte , L , Rezeberga , D & Miskova , A 2023 , ' Management of Pregnancy with Cervical Shortening: Real-Life Clinical Challenges ' , Medicina (Kaunas) , vol. 59 , no. 4 , 653 . https://doi.org/10.3390/medicina59040653 |
Abstract: | Background and Objectives: Preterm birth is the leading cause of neonatal mortality worldwide and may be responsible for lifelong morbidities in the survivors. Cervical shortening is one of the common pathways to preterm birth associated with its own diagnostic and management challenges. The preventive modalities that have been tested include progesterone supplementation and cervical cerclage and pessaries. The study aimed to assess the management strategies and outcomes in a group of patients with a short cervix during pregnancy or cervical insufficiency. Materials and Methods: Seventy patients from the Riga Maternity Hospital in Riga, Latvia, were included in the prospective longitudinal cohort study between 2017 and 2021. Patients were treated with progesterone, cerclage, and/or pessaries. The signs of intra-amniotic infection/inflammation were assessed, and antibacterial therapy was given when the signs were positive. Results: The rates of PTB were 43.6% (n = 17), 45.5% (n = 5), 61.1% (n = 11), and 50.0% (n = 1) in progesterone only, cerclage, pessary, and cerclage plus pesssary groups, respectively. The progesterone therapy was associated with a reduced preterm birth risk (x2(1) = 6.937, p = 0.008)), whereas positive signs of intra-amniotic infection/inflammation significantly predicted the risk of preterm birth (p = 0.005, OR = 3.82, 95% [CI 1.31–11.11]). Conclusions: A short cervix and bulging membranes, both indicators of intra-amniotic infection/inflammation, are the key risk factors in preterm birth risk predictions. Progesterone supplementation should remain at the forefront of preterm birth prevention. Among patients with a short cervix and especially complex anamnesis, the preterm rates remain high. The successful management of patients with cervical shortening lies between the consensus-based approach for screening, follow-up, and treatment on the one side and personalising medical therapy on the other. |
Description: | Funding Information: The study was funded by the Fundamental and Applied Research Projects grant of The Latvian Council of Science (Project No. 2020/1-0042 to DR). The funders had no role in the study design, data collection or analysis, decision to publish, or preparation of the manuscript. Publisher Copyright: © 2023 by the authors. |
DOI: | 10.3390/medicina59040653 |
ISSN: | 1010-660X |
Appears in Collections: | Research outputs from Pure / Zinātniskās darbības rezultāti no ZDIS Pure |
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