First experience of ligature and titanium complex application in surgical correction of isthmic-cervical insufficiency
Authors:   I.M.Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russian Federation, Ishchenko A.I. , Zemlina N.S. ,   I.M.Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russian Federation, Borisova N.I. ,   I.M.Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russian Federation, Goncharenko N.V. ,   I.M.Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russian Federation, Khokhlova I.D. ,   I.M.Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russian Federation, Azarova O.Yu. ,   I.M.Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russian Federation, Fedorova E.V. ,   I.M.Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russian Federation, Dzhibladze T.A. ,   I.M.Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russian Federation, Proklova G.F. ,   I.M.Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russian Federation, Aleksandrov L.S. ,   I.M.Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russian Federation, Gorbenko O.Yu. ,   I.M.Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russian Federation, Melnik E.V. ,   I.M.Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russian Federation, Pkhakadze L.M. ,   I.M.Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russian Federation, Bairamova T.S. ,   I.M.Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russian Federation
Published: January 2025

Objective. To improve the efficacy and safety of cervical cerclage using the ligature and titanium complex in patients with isthmic-cervical insufficiency (ICI).
Patients and methods. The study included 50 pregnant women with ICI aged 26–43 years. Cervical cerclage was performed according to the developed original surgical technique by placing a non-absorbable ligature with two titanium fixators. Dynamic follow-up in the postoperative period was performed every month before labor and for 2 months postpartum. Ultrasound examination was performed on day 3–4 after surgical correction of ICI using a three-dimensional image reconstruction of the suture area in the VOCAL program. Pregnancy course and outcomes were analyzed.
Results. No intraoperative complications associated with the ligature and titanium complex were identified. According to ultrasound findings, no cervical blood supply disorders were observed in the early postoperative period. Four (8%) patients required hospitalization due to threatened preterm labor at 28–34 weeks of gestation. By the time of writing this article, 32 (64%) women had given birth, and in the remaining 18 (36%) patients the pregnancy progressed. The ligature and titanium complex (non-absorbable suture and two titanium fixators placed on the cervix) was removed in all 32 (64%) patients without technical
difficulties. A total of 30 (93.75%) of the 32 women had labor at term, including vaginal delivery in 14 (46.7%) and operative delivery (cesarean section) in 16 (50%) patients. Labor at 28 and 34 weeks occurred in 2 (6.05%) patients due to premature rupture of membranes and severe pre-eclampsia, respectively.
Conclusion. This study demonstrates the efficacy and safety of the developed original surgical technique of cervical cerclage by placing a non-absorbable ligature with two titanium fixators in patients with ICI, including those with cervical shortening. Several advantages of this technique are evidenced by the possibility of dosed tension of the suture material in the cervical tissue, which prevents not only the suture from cutting through, sinking or sagging, but also the formation of ligature fistulas. The developed method of ICI treatment improves pregnancy outcomes, which necessitates the introduction of the new
technique into widespread obstetric practice.
Key words: isthmic-cervical insufficiency, cerclage, ligature and titanium complex, titanium fixators, VOCAL program, three-dimensional cervical reconstruction, cervical vascularity index, labor at term, preterm labor