Pregnancy, childbirth and perinatal outcomes in isthmic-cervical insufficiency, depending on the method of delivery
Authors: Khvorostukhina N. F. , Stepanova N. N. , Novichkov D. A. , Mikhailova Ju. V. , Trushina O. V. , Odnokozova O. S. , Kirillova N. A. 
Published: April 2022

Introduction. Isthmic-cervical insufficiency (ICI) continues to be one of the main causes of miscarriage and premature birth (PB), contributing to the growth of reproductive losses and directly affecting the indicators of perinatal morbidity and mortality.

Objectiveof the study – to study the features of the course of pregnancy, childbirth and perinatal outcomes in ICI, depending on the method of delivery.

Material and methods.A retrospective analysis of birth histories (n = 144) with a diagnosis of Isthmic-cervical insufficiency was carried out, for the period from 2015 to 2020. 102 pregnant women who delivered through the natural birth canal (70.8%) made up group 1, and 42 women whose births ended with cesarean section (29.2%) made up group 2. The control groups included patients with a singleton uncomplicated pregnancy, which ended with an emergency delivery through the natural birth canal (group 3 – n = 96) and by caesarean section (group 4 – n = 58). Anamnestic data, peculiarities of the course of pregnancy, childbirth and perinatal outcomes were studied in detail. Statistical analysis was carried out using the programs Excel MS Office Professional and STATISTICA 7.0.

Results and discussion. ICI is more common in repeat-bearing women with a male fetus (p < 0.001), with a burdened obstetric and gynecological history, concomitant extragenital pathology, over the age of 30 years. In PB, conservative management of the birth act prevails against the background of ICI (70.8%) (p >< 0.001). The choice of delivery method in ICI determines the gestation period, fetal condition, the occurrence of urgent obstetric complications and premature rupture of fetal membranes. With ICI, the birth of children in a state of asphyxia prevails (p >< 0.001). With operative delivery, the probability of diagnosing mild asphyxia (1.3 times) and respiratory distress syndrome (2 times) increases. With conservative management of childbirth against the background of ICI in newborns, the frequency of grade I cerebral ischemia increases significantly (by 5 times) (p >< 0.001). Conclusion. The results of the study once again confirmed the significant importance of the ICI in the implementation of PB, which dictates the need for further study of this problem to improve the quality of care for pregnant women and improve perinatal outcomes. >< 0.001), with a burdened obstetric and gynecological history, concomitant extragenital pathology, over the age of 30 years. In PB, conservative management of the birth act prevails against the background of ICI (70.8%) (p < 0.001). The choice of delivery method in ICI determines the gestation period, fetal condition, the occurrence of urgent obstetric complications and premature rupture of fetal membranes. With ICI, the birth of children in a state of asphyxia prevails (p >< 0.001). With operative delivery, the probability of diagnosing mild asphyxia (1.3 times) and respiratory distress syndrome (2 times) increases. With conservative management of childbirth against the background of ICI in newborns, the frequency of grade I cerebral ischemia increases significantly (by 5 times) (p >< 0.001). Conclusion. The results of the study once again confirmed the significant importance of the ICI in the implementation of PB, which dictates the need for further study of this problem to improve the quality of care for pregnant women and improve perinatal outcomes.>< 0.001). The choice of delivery method in ICI determines the gestation period, fetal condition, the occurrence of urgent obstetric complications and premature rupture of fetal membranes. With ICI, the birth of children in a state of asphyxia prevails (p < 0.001). With operative delivery, the probability of diagnosing mild asphyxia (1.3 times) and respiratory distress syndrome (2 times) increases. With conservative management of childbirth against the background of ICI in newborns, the frequency of grade I cerebral ischemia increases significantly (by 5 times) (p >< 0.001). Conclusion. The results of the study once again confirmed the significant importance of the ICI in the implementation of PB, which dictates the need for further study of this problem to improve the quality of care for pregnant women and improve perinatal outcomes.><  0.001). With operative delivery, the probability of diagnosing mild asphyxia (1.3 times) and respiratory distress syndrome (2 times) increases. With conservative management of childbirth against the background of ICI in newborns, the frequency of grade I cerebral ischemia increases significantly (by 5 times) (p < 0.001). Conclusion. The results of the study once again confirmed the significant importance of the ICI in the implementation of PB, which dictates the need for further study of this problem to improve the quality of care for pregnant women and improve perinatal outcomes.>< 0.001).

Conclusion.The results of the study once again confirmed the significant importance of the ICI in the implementation of PB, which dictates the need for further study of this problem to improve the quality of care for pregnant women and improve perinatal outcomes.