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Introduction. Premature birth is the leading cause of perinatal morbidity and mortality and its prevention is a priority for maternal-fetal medicine. Our paper presents an analysis of the pregnancy outcome in patients diagnosed with a sonographic short cervix after treatment by three different methods: progesterone, cervical cerclage and vaginal pessary. Methods. We selected representative articles from literature and analyzed the pregnancy outcome in women diagnosed with a short cervix by ultrasound in the second trimester and treated with progesterone, cerclage cervical and vaginal pessary. Results. Ultrasound diagnosis of a short cervix is the most important sign that predicts premature birth. Progesterone administered by vaginal route (in the form of200 mg tablets or 90 mg gel) was associated with a statistically significant reduction in the incidence of preterm birth and perinatal morbidity and mortality. Cervical cerclage and vaginal pessary reduce the rate of premature births only in certain cases and there is no significant difference between the treatment with progesterone and cerclage/pessary to prevent prematurity. Conclusions. In singleton pregnancy with a short cervix, without obstetrical history of premature births, progesterone reduces the incidence of preterm birth and neonatal morbidity and mortality. In twin pregnancy with a short cervix, cerclage is inefficient for preventing preterm birth and progesterone may be effective to improve neonatal outcome. Vaginal pessary is inefficient in reducing premature birth rates both for singleton and twin pregnancies. [ABSTRACT FROM AUTHOR]

Introduction. Cervical cerclage is a surgical intervention involving placing a stitch around the uterine cervix. Arabin pessary is another way to increase cervical containment. Although their effectiveness and safety in asymptomatic multiple gestations remain controversial, their use, even combined, in cases of multiple pregnancy with threatened preterm labor, appears to be effective. Materials and method. This is a prospective analysis of 12 cases of multiple pregnancies in our clinic. The study group was composed of twin or triple (one) primigravida pregnancies with high risk factors for preterm labor. Cervical lenght and dilatation of internal cervical os were evaluated with transvaginal ultrasound in the second and third trimesters of pregnancy. We used Arabin pessary for cervical length between 25 and 15 mm with dilatation of internal os more than 10 mm (nine cases). When we found the cervix less than 15 mm, the procedure consisted of cervical cerclage followed by mounting a contention pessary (three cases). In three cases (two twin and the triple pregnancy), the cervical cerclaje and/or pessary were removed at 34 weeks due to premature labor. In the remaining cases (nine), these were removed at 36 weeks of gestation. Results and conclusions. All pregnant women have born healthy babies. There were no severe complications or adverse effects due to the application of this protocol. Although there was no control group in this study, we can say that cervical containment methods provide the prolongation of the pregnancy beyond 34 weeks, preventing serious neonatal mortality and morbidity. [ABSTRACT FROM AUTHOR]

Introduction. One of the most common causes of late abortion or severe prematurity is represented by cervical incompetence. Cervical shortening and dilation are the consequence of sustained uterine contractions, often asymptomatic. In most cases, the triggering factor is the infectious pathology and the secondary inflammation. The cervical cerclage is a surgical maneuver designed to create a barrier between the non-sterile vaginal environment and the uterine cavity. This procedure is performed after the acute episode is treated, but there are cases when it will be performed concomitantly with the drug treatment. Materials and method. We present a series of cases of cervical surgery performed in patients with a gestational age between 19 and 22 weeks, with an infectious component present. The procedure was realized by installing a double, non-absorbable thread, at the level of the cervix, which was suppressed at 37 gestational weeks. Results. The tasks evolved favorably until 38-39 gestational weeks, when the RPPM, respectively sustained UC took place. The ribbon was suppressed, and the patients gave birth spontaneously, respectively by caesarean section, when necessary. Conclusions. Despite the fact that the success rate of the ribbon performed in the presence of the uterine contractions is low, there are situations when this may represent the last solution for the prevention of the late abortion, respectively the premature birth. [ABSTRACT FROM AUTHOR]

A 30-year-old pregnant women, nullipara, with two embryos death, former Yaz® user (one year), without antiphospholipid antibodies, with prophylactic cervical cerclage at 19 weeks pregnancy, is readmitted in emergency at 21 weeks for heavy pelvic pains, and abundant vaginal blood loss, with cerclage suppression, and under tocolysis and progesterone she presents three new episodes of intense pains and red, pulsatile blood loss from different cervical areas at 24-36 hours after admittance, with mechanical hemostasis by nylon sutures at cervico-vaginal junction. The fourth episode is followed by severe anemia (Hb=6.03 mg/dL, Ht=18.32%), haemodinamic instability, coagulation disorders - hematomas, generalized petaechia, and at 24 hours after the last vaginal sutures she claims thoracic pains, dyspnoea, and cianosis. There are not registered fetal distress, placental abnormalities, cervical shortness below 2.5 cm or maternal heart abnormalities at the ultrasound examination. Thoracic computed tomography was not done, because the mother refused. After cardiologist consultation, it was appreciated a mild/moderate pulmonary thromboembolism, without deep legs venouos thrombosis, and it was initiated the continuous intravenous anticoagulant therapy - heparine 25.000 UI/day x 6 days, then fraxiparine in increased dosage continued to term, and during six weeks postpartum. The laboratory test confirmed the intravascular disseminated coagulation with secondary fibrinolysis, and positive for heterozygous mutants of MTHFR (methylene tetrahydrofolate reductase deficiency C677T and A1298C), and PAI-1 (4G). Caesarean delivery was performed at 37 weeks for foetal distress at labor onset, with the extraction of a girl, 3340 g weight, Apgar score = 7/8, with premature senescent placenta and thin umbilical cord. The postpartum evolution of the baby and mother was normal. [ABSTRACT FROM AUTHOR]

The role of cervical cerclage in prolonging the gestational age constitutes a controversial topic in modern obstetrics, especially due to the increased morbidity and mortality associated with premature birth. The cervical cerclage represents an obstetrical manoeuver that strengthens the cervix, prevents amniotic membrane prolabation and preterm premature rupture of membranes, and extends the gestational age in singleton pregnancies. There are three distinct situations in which cerclage can be beneficial: prophylactic cerclage for cervical insufficiency; therapeutic cerclage, when ultrasound transvaginal evaluation of the cervix identifies modifications of length and/or shape, and emergency cerclage, in situations when we have dilatation of the cervix. The aim of our study was to asses retrospectively the circumstances of cervical cerclage in our clinic and to evaluate the benefits of this obstetrical manoeuver in prolonging the gestational age. [ABSTRACT FROM AUTHOR]