Cervical incompetence Archives - Revista Brasileira de Ginecologia e Obstetrícia
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 1999;21(3):171-174
DOI 10.1590/S0100-72031999000300009
In pregnant women with cervical incompetence in whom there is also dilatation of the cervix and prolapsed membranes there are technical difficulties in performing cerclage in order to prolongate pregnancy until sufficient fetal maturity assures survival of the newborn. We describe a case of cervical incompetence with prolapsed membranes at 21 weeks of gestation, in which we caused the decrease of intrauterine pressure with drainage of amniotic fluid by amniocentesis, until reintroduction of membranes into the uterine cavity was possible. This procedure allowed traction of cervical lips and cerclage with less mechanical trauma, warranting the evolution of pregnancy for 12 weeks and fetal survival
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 1999;21(3):171-174
DOI 10.1590/S0100-72031999000300009
In pregnant women with cervical incompetence in whom there is also dilatation of the cervix and prolapsed membranes there are technical difficulties in performing cerclage in order to prolongate pregnancy until sufficient fetal maturity assures survival of the newborn. We describe a case of cervical incompetence with prolapsed membranes at 21 weeks of gestation, in which we caused the decrease of intrauterine pressure with drainage of amniotic fluid by amniocentesis, until reintroduction of membranes into the uterine cavity was possible. This procedure allowed traction of cervical lips and cerclage with less mechanical trauma, warranting the evolution of pregnancy for 12 weeks and fetal survival
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2000;22(4):217-223
DOI 10.1590/S0100-72032000000400005
Purpose: to identify recurrent spontaneous abortion- associated factors. Subjects: one hundred seventy-five outpatients were investigated from March 1993 to March 1997 at the "Ambulatório de Aborto Recorrente CAISM/UNICAMP". All of them had had three or more consecutive spontaneous abortions and/or two abortions and were 35 years or more old. Methods: the investigation protocol included: couple's karyotype; hysterosalpingography, serial plasma progesterone levels and/or endometrial biopsy; toxoplasmosis, listeriosis, brucelosis, lues and cytomegalovirus serum tests; Chlamydia trachomatis and Mycoplasma hominis cultures of cervical discharge; TSH and thyroid hormone levels; fasting glucose; autoantibody panel, anti-HLA antibody search by microlymphocytotoxicity crossmatch and one-way mixed lymphocyte culture with inhibitor factor detection. Husband's evaluation included: physical evaluation, lues, Chagas' disease, B and C hepatitis and AIDS serum tests, microlymphocytotoxicity crossmatch and one-way mixed lymphocyte culture with inhibitor factor detection. Results: alloimmune etiology was the most frequently found factor (86.3% of studied patients), represented by negative crossmatch and one-way mixed lymphocyte culture with inhibitor factor below 50%. The second most frequently found factor was cervical incompetence (22.8%), followed by hormonal factor (21.2%), mainly represented by luteal insufficiency. Some patients were found to have more than one etiologic factor. Conclusion: the investigation of recurrent spontaneous abortion-associated factors must include alloimmune etiology. Most cases will remain unexplained without this investigation.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2000;22(4):217-223
DOI 10.1590/S0100-72032000000400005
Purpose: to identify recurrent spontaneous abortion- associated factors. Subjects: one hundred seventy-five outpatients were investigated from March 1993 to March 1997 at the "Ambulatório de Aborto Recorrente CAISM/UNICAMP". All of them had had three or more consecutive spontaneous abortions and/or two abortions and were 35 years or more old. Methods: the investigation protocol included: couple's karyotype; hysterosalpingography, serial plasma progesterone levels and/or endometrial biopsy; toxoplasmosis, listeriosis, brucelosis, lues and cytomegalovirus serum tests; Chlamydia trachomatis and Mycoplasma hominis cultures of cervical discharge; TSH and thyroid hormone levels; fasting glucose; autoantibody panel, anti-HLA antibody search by microlymphocytotoxicity crossmatch and one-way mixed lymphocyte culture with inhibitor factor detection. Husband's evaluation included: physical evaluation, lues, Chagas' disease, B and C hepatitis and AIDS serum tests, microlymphocytotoxicity crossmatch and one-way mixed lymphocyte culture with inhibitor factor detection. Results: alloimmune etiology was the most frequently found factor (86.3% of studied patients), represented by negative crossmatch and one-way mixed lymphocyte culture with inhibitor factor below 50%. The second most frequently found factor was cervical incompetence (22.8%), followed by hormonal factor (21.2%), mainly represented by luteal insufficiency. Some patients were found to have more than one etiologic factor. Conclusion: the investigation of recurrent spontaneous abortion-associated factors must include alloimmune etiology. Most cases will remain unexplained without this investigation.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2003;25(7):483-489
DOI 10.1590/S0100-72032003000700004
PURPOSE: to describe the pregnancy outcome of women submitted to cervical cerclage during pregnancy. METHODS: a series of 123 pregnancies in 116 women submitted to elective cervical cerclage by Espinosa-Bahamondes, Palmer and MacDonald techniques and followed at the High-Risk Antenatal Care Unit at CAISM/UNICAMP is described. Variables were analyzed through frequency, mean and standard deviation, comparisons were made using c² or Fisher exact tests. RESULTS: 73% had at least one previous abortion, 17.9% had had 3 prior abortions, and 48% had prior preterm deliveries. The mean gestational age at cerclage was 16 weeks. Cerclage by the Espinosa-Bahamondes technique predominated (94.3%). The overall complication rate was 69%, with preterm labor as the most frequent (31.7%), followed by vaginitis (26%), preterm premature rupture of membranes (10.5%) and fetal death (8.7%). Other clinical complications were less common and included urinary tract infections (5.6%), hypertensive disorders (4%) and gestational diabetes (2.4%). Fetal loss occurred in 8.9% of pregnancies (11 stillbirths). Premature deliveries were present in 18%. History of previous premature deliveries was associated with the occurrence of premature deliveries. CONCLUSION: Obstetrical history compatible with cervical incompetence was frequent, and prior preterm delivery was associated with a preterm delivery in the pregnancy under analysis. The use of cerclage by the Espinosa-Bahamondes technique resulted in 18% of premature newborns, and 104 per thousand rate of perinatal death. Prospective, controlled trials are needed to evaluate the real benefits of cervical cerclage performed during pregnancy.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2003;25(7):483-489
DOI 10.1590/S0100-72032003000700004
PURPOSE: to describe the pregnancy outcome of women submitted to cervical cerclage during pregnancy. METHODS: a series of 123 pregnancies in 116 women submitted to elective cervical cerclage by Espinosa-Bahamondes, Palmer and MacDonald techniques and followed at the High-Risk Antenatal Care Unit at CAISM/UNICAMP is described. Variables were analyzed through frequency, mean and standard deviation, comparisons were made using c² or Fisher exact tests. RESULTS: 73% had at least one previous abortion, 17.9% had had 3 prior abortions, and 48% had prior preterm deliveries. The mean gestational age at cerclage was 16 weeks. Cerclage by the Espinosa-Bahamondes technique predominated (94.3%). The overall complication rate was 69%, with preterm labor as the most frequent (31.7%), followed by vaginitis (26%), preterm premature rupture of membranes (10.5%) and fetal death (8.7%). Other clinical complications were less common and included urinary tract infections (5.6%), hypertensive disorders (4%) and gestational diabetes (2.4%). Fetal loss occurred in 8.9% of pregnancies (11 stillbirths). Premature deliveries were present in 18%. History of previous premature deliveries was associated with the occurrence of premature deliveries. CONCLUSION: Obstetrical history compatible with cervical incompetence was frequent, and prior preterm delivery was associated with a preterm delivery in the pregnancy under analysis. The use of cerclage by the Espinosa-Bahamondes technique resulted in 18% of premature newborns, and 104 per thousand rate of perinatal death. Prospective, controlled trials are needed to evaluate the real benefits of cervical cerclage performed during pregnancy.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2003;25(1):29-34
DOI 10.1590/S0100-72032003000100005
PURPOSE: to identify characteristics common to women who suffer from cervical incompetence (CI) allowing their early identification and helping in the follow-up of the gestational-postdelivery cycle. PATIENTS AND METHODS: fifty pregnant women suffering from CI and submitted to uterine cerclage according to modified McDonald's technique were analyzed in an observational descriptive study. The following variables of the medical records were evaluated: age, preceding obstetrical aspects, time of CI diagnosis, cerclage-related aspects and preterm delivery incidence. RESULTS: the average age of the mothers was 29.28 years and mean number of previous gestations was 3.76. As to the preceding obstetrical aspects, 189 gestations with a CI diagnosis were reported and cerclage had been applied to 18 of them, resulting in 18 babies who were born alive (8 preterm deliveries and 10 term deliveries). Of the 171 previous pregnancies in which CI diagnosis was not reported, 90 progressed to abortion, 68 were preterm and 13 were term deliveries. In 30 (60%) patients, CI was diagnosed during the intergestational interval, and 20 (40%) during gestation. The average gestational period in which patients were submitted to cerclage was 18.29 weeks; 40% of the cerclages were emergency procedures and 60% were elective. The incidence of prematurity was 30% (15/50). CONCLUSION: careful obstetrical evaluation of multiparous women, presenting recurrent miscarriages, during the intergestational interval and/or during the first trimester of pregnancy, may allow the early diagnosis and adequate treatment of CI, avoiding prematurity.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2003;25(1):29-34
DOI 10.1590/S0100-72032003000100005
PURPOSE: to identify characteristics common to women who suffer from cervical incompetence (CI) allowing their early identification and helping in the follow-up of the gestational-postdelivery cycle. PATIENTS AND METHODS: fifty pregnant women suffering from CI and submitted to uterine cerclage according to modified McDonald's technique were analyzed in an observational descriptive study. The following variables of the medical records were evaluated: age, preceding obstetrical aspects, time of CI diagnosis, cerclage-related aspects and preterm delivery incidence. RESULTS: the average age of the mothers was 29.28 years and mean number of previous gestations was 3.76. As to the preceding obstetrical aspects, 189 gestations with a CI diagnosis were reported and cerclage had been applied to 18 of them, resulting in 18 babies who were born alive (8 preterm deliveries and 10 term deliveries). Of the 171 previous pregnancies in which CI diagnosis was not reported, 90 progressed to abortion, 68 were preterm and 13 were term deliveries. In 30 (60%) patients, CI was diagnosed during the intergestational interval, and 20 (40%) during gestation. The average gestational period in which patients were submitted to cerclage was 18.29 weeks; 40% of the cerclages were emergency procedures and 60% were elective. The incidence of prematurity was 30% (15/50). CONCLUSION: careful obstetrical evaluation of multiparous women, presenting recurrent miscarriages, during the intergestational interval and/or during the first trimester of pregnancy, may allow the early diagnosis and adequate treatment of CI, avoiding prematurity.
