Niewydolność cieśniowo-szyjkowa u kobiet ciężarnych – profilaktyka i postępowanie lecznicze

*Urszula Marzec¹, Krzysztof Marzec²

Summary
Cervical incompetence is the inability of the cervix to maintain pregnancy to term due to disturbances of it is functions. The frequency of this complication is 0.1-1.8%. The consequences of cervical incompetence are miscarriages and premature births. The etiology of cervical incompetence is complex and multifactorial. The clinical diagnosis of cervical incompetence can be a big diagnostic problem because of the frequent asymptomatic course. A transvaginal ultrasound examination and a clinical examination are currently recommended for early detection of the symptoms of cervical incompetence. The contraction and dilation of the cervix, and the invagination of the lower pole of the egg fetus to the uterine cervix, authorize the diagnosis of cervical incompetence. The limit value of the cervical canal length is assumed to be 25 mm which is the value of 10 percentile of the cervical canal length between 16-24 weeks of pregnancy. It is recommended that in the low-risk group of pregnant women the first transvaginal ultrasound scan should be performed between 18-22 weeks of pregnancy, but in the group of pregnant women at high risk between 14-18 weeks of pregnancy. Procedures in case of cervical incompetence comprise surgery, medical therapy, an expectant attitude and a combination of all those methods. The surgery uses cerclages. The effectiveness of Mc Donald and Shirodkar cerclages (introduced vaginally) is high and reaches 89% in relation to the favorable termination of pregnancy. The abdominal seam is implemented from the abdominal access and currently rarely applied. The use of the prophylactic drug treatment of progesterone in pregnant patients with asymptomatic shortened cervix on an ultrasound scan, significantly prolongs the duration of pregnancy and reduces the percentage of premature births. Currently the alternative to cerclages are pessaries, whose placement and removal carry a lower risk of complications and have a comparable effectiveness to cerclages. Cervical incompetence is still a significant midwifery problem. Treatment effects vary depending on the advancement of cervical incompetence at the time of diagnosis. Early diagnosis of cervical incompetence allows you to implement an appropriate treatment and reduce the incidence of miscarriages and premature births.

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