Analysis of risk factors and predictors of pregnancy loss and strategies for the management of cervical insufficiency in pregnant women at a high risk of preterm birth.

Abstract

Aim of the study: To identify risk factors and predictors of pregnancy loss and to compare the efficacy of Arabin s pessary with cervical cerclage in women at a high risk of pregnancy loss. Materials and methods: This was a two-centre retrospective case-control study that included 240 women at a high risk of preterm delivery. Group I (n = 161) included women who underwent insertion of the Arabin s pessary between 14-24\xa0weeks of pregnancy. Group II (n = 79) included women who had undergone circular cervical cerclage during the current pregnancy. All women included in the study received micronised vaginal progesterone at the dose of 200\xa0mg/day until and including 34\xa0weeks of gestation. Results: Threatened pregnancy loss defined as spotting or vaginal bleeding in the first trimester was diagnosed in 29.8% (48/161) of patients in Group I versus 37.9% in Group II (p = 0.448). Postpartum bleeding occurred in 8.1% (13/161) in women in Group I versus 22.8% in Group II (χ2 = 6.500; p = 0.011). Our study showed that cervical cerclage was most suitable for patients with history of obstetric complications, cervical length < 15\xa0mm, and large isthmic uterine fibroids. The use of the Arabin s pessary reduced the rate of preterm births by 1.7-fold. A cluster analysis demonstrated that predictors of preterm birth in women with a high risk of pregnancy loss included: threatened pregnancy loss associated with chorionic/placental abruption; cervical incompetence; uterine fibroid growth to a large size; history of multiple spontaneous pregnancy losses; cervical tears during past labour; and gestational diabetes diagnosed for the first time during the current pregnancy. Conclusions: Women with a high risk of pregnancy loss treated with Arabin s pessary or cerclage plus vaginal progesterone had a term delivery rate of 70.4% (169/240). The combined strategy of pregnancy management allowed to markedly reduce the number of preterm births.