Prediction of Spontaneous Preterm Birth in Women with Ischemic-Cervical Insufficiency Corrected with the Pessary

Abstract

Objective: to develop a model for prediction of spontaneous preterm birth (SPB) in women with ischemic-cervical insufficiency (ICI), identified and corrected with the pessary at the term 19-23/6 weeks of gestation.

Material and methods: 90 female patients with ischemic-cervical insufficiency, identified at 19-23/6 weeks of gestation (group 1 (n = 34) included women who gave preterm birth, group 2 (n = 56) were women who gave term birth), have been examined.

Results. The risk factors for SPB in the patients with ICI vary depending on the gestational age. The significant risk factors before the detection of ICI are: miscarriage; absence of term birth in the past history of multiparous women; violation of the vaginal microflora; transmitted urogenital infections. The risk factors for SPB at the time of the ICI verification: «sludge» in the lower pole of the fetal bladder; symptomatic variant of the course of ICI; low values of fluorescence protein in the cervical mucus. The risk factors for SPB after the performed correction of the ICI with the pessary are: high UCA values at 24 and 28 weeks of gestation; «sludge» in the amniotic fluid; tone of the lower segment of the uterus; reduced length of the closed part of the cervical cervix; pessary displacement. A dynamic prognosis will make it possible to identify the risk group for SPB at each stage of the management of preg-nant women, which will improve perinatal outcomes.

Conclusion. The proposed prognostic model (AUC = 0.935; Se = 76.5%; Sp = 96.4 %; 95% CI 0.86-0.98; p = 0.0001) has a high diagnostic efficiency of 90.3 %.