DIAGNOSIS AND MANAGEMENT TACTICS OF PATIENTS WITH ISTHMICO-CERVICAL INSUFFICIENCY

Аннотация

The article is devoted to diagnostic methods, therapeutic options, and management algorithms for patients with isthmic-cervical insufficiency (ICI). Acquired and congenital abnormalities of the cervix are risk factors for the development of ICI. The diagnosis is valid only during pregnancy. A shortening of the length of the cervix of less than 25 mm indicates the presence of ICI and the risk of premature birth. The optimal time for the initial assessment of the length of the cervix is 16-20 weeks. If the length of the cervix is more than 25 mm, but less than 30 mm, micronized progesterone 200 mg is prescribed into the vagina for preventive purposes from 19 to 34 weeks. When ICI is detected after 24 weeks, the method of choice is the appointment of micronized progesterone and the installation of an obstetric discharge pessary. Shortening of the length of the cervix up to 24 weeks of pregnancy is an indication for surgical correction and cerclage followed by micronized progesterone therapy. The use of a differentiated management algorithm for patients with ICI reduces the likelihood of unexpected premature birth and neonatal morbidity and mortality. Keywords: isthmic-cervical insufficiency, premature birth, miscarriage, cerclage, obstetric pessary, micronized progesterone, cervicometry, elastometry.