PhD degree dissertation in the field of study 22 Healthcare by Program Subject
Area 222 Medicine (14.01.01 Obstetrics and Gynecology). Kyiv: Shupyk National
Healthcare University of Ukraine of MН Ukraine; 2023.
The dissertation is devoted to increasing the effectiveness of the treatment of
habitual miscarriage, reducing the frequency of termination of pregnancy and
premature birth by optimizing the management tactics of such women with a
differentiated approach based on the application of predicting the ineffectiveness of
the vaginal cerclage and the use of an innovative intracorporeal suture application
method.
A retrospective analysis of 8728 histories of pregnancy and childbirth
established the frequency of isthmic-cervical insufficiency (ICI), which averaged
1.9% over 5 years, with some upward trend from 1.6% to 2.0-2.2%. 2 subgroups were
selected for analysis: 166 patients with ICI (main group) and 50 patients without ICI
(control group).
The medical and social features of pregnant women with ICI have been
established. 27.1% are women over the age of 35. Only a third (33.7%) of women are
considered physically healthy. Metabolic syndrome/obesity (19.9%) and diseases of
the urinary system (27.7%) stood out in the structure of morbidity. Infectious
pathology of the urinary-excretory sphere is observed in 25.9% of patients, in 53.0% a
burdened gynecological history: cervical ectopia (33.7%), chronic infectious diseases
of the genital sphere (16.3%), 25.9%. underwent excision of the cervix, 42.8%
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underwent intrauterine interventions with dilation of the cervical canal, and 59.2% of
them twice or more. Spontaneous miscarriages and medical abortions are noted by
27.7% and 33.7% of women, 18.1% - frozen pregnancy, while habitual miscarriage is
diagnosed in 15.7% of patients. The following methods of ICI correction were used:
cervical cerclage in 42.2% of cases, installation of an obstetric pessary in 30.7%,
cervical cerclage and obstetric pessary in 12.0%, recommendations to limit physical
activity and the use of progesterone in 15.1%. In pregnancy burdened by ICI, the
threat of termination is most often noted (51.2%), followed by an exacerbation of a
genitourinary infection (41.0%) and the threat of premature birth (38.0%). Premature
birth occurred in 38.0% of cases, in 31.9% - premature rupture of the fetal
membranes. The tactic with the imposition of a cerclage on the cervix was the most
effective in terms of preventing adverse pregnancy outcomes - the frequency of
premature birth was 31.4%, progesterone therapy was the least effective (52.0%).
130 pregnant women were comprehensively examined: the main group - 80
pregnant women with isthmic-cervical insufficiency, the correction of which was
carried out with the use of a cerclage, the control group consisted of 50 pregnant
women without ICI. After prospectively monitoring the outcome of pregnancy in the
women of the main group, 2 subgroups were selected to fulfill the task: ICI1 - 34
(42.5%) women with an unfavorable pregnancy termination (miscarriage before 22
weeks of pregnancy in 4 women and premature birth in 30 patients) and ICI2 - 46
(57.5%) patients in whom childbirth was urgent). The lowest frequency of adverse
consequences was noted with prophylactic cerclage, and the highest – with
emergency. The structure of the unfavorable end of pregnancy after the correction of
ICI by applying a transvaginal suture: late miscarriages – 11.8%, premature births up
to 28 weeks of pregnancy – 32.8%, 28-33 weeks – 20.6%, 34-36 weeks – 35.3%.
The most significant factors of unfavorable pregnancy termination include: the
threat of premature birth in this pregnancy (73.5% vs. 21.7%, p<0.05; OR=10.00, CI:
3.55; 28.15, p <0.05), spontaneous miscarriages in history 47.1% versus 13.0%,
p<0.05; OR=5.93, DI: 1.99; 17.64, p<0.05), signs of undifferentiated connective
tissue dysplasia (76.5% vs. 37.0%, p<0.05, OR=5.54, CI: 2.05; 14.97), infectious
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diseases of the urinary system (44.1% vs. 15.2%, p<0.05, OR=4.4, CI: 1.54; 12.59,
p<0.05), threat of abortion (79, 4% vs. 43.5%, p<0.05; OR=5.01, CI: 1.82; 13.84,
p<0.05), 2 or more intrauterine interventions with dilation of the cervical canal (41.2
% vs. 13.0%, OR=4.67, CI: 1.56; 13.97, p<0.05), diseases of the cardiovascular
system (35.3% vs. 10.9%, p<0, 05, OR=4.47, CI: 1.40; 14.34, p<0.05), gestational
diabetes during this pregnancy (23.5% vs. 6.5%, p<0.05; OR=4 ,41, CI: 1.07; 18.13,
p<0.05), diseases of the urinary system (44.1% vs. 15.2%, p<0.05, OR=4.4, CI: 1, 54;
12.59, p<0.05), autonomic dysfunction syndrome (41.2% vs. 15.2%, p<0.05, OR
=3.90, CI: 1.36; 11.20, p <0.05), chronic endometritis/salpingo-oophoritis (26.5% vs.
8.7%, p<0.05; OR =3.78, CI: 1.05; 13.56, p<0.05), exacerbation of genitourinary
infection (58.8% vs. 28.3%, p<0.05; OR =3.63, DI: 1.42; 9.26, p<0.05) in this
pregnancy.
