Geburtshilfe Frauenheilkd 2014; 74(11): 1003-1008
DOI: 10.1055/s-0034-1383271
Original Article
GebFra Science
Georg Thieme Verlag KG Stuttgart · New York

Is Early Treatment with a Cervical Pessary an Option in Patients with a History of Surgical Conisation and a Short Cervix?

Ist die frühe Behandlung mit einem zervikalen Pessar eine Option für Patientinnen nach Konisation und Zervixverkürzung?
I. Kyvernitakis
Department of Gynecology and Obstetrics, Philipps-University of Marburg, Marburg , in cooperation with the Clara Angela Foundation, Witten
,
R. Khatib
Department of Gynecology and Obstetrics, Philipps-University of Marburg, Marburg , in cooperation with the Clara Angela Foundation, Witten
Department of Gynecology and Obstetrics, Philipps-University of Marburg, Marburg , in cooperation with the Clara Angela Foundation, Witten
,
N. Stricker
Department of Gynecology and Obstetrics, Philipps-University of Marburg, Marburg , in cooperation with the Clara Angela Foundation, Witten
Department of Gynecology and Obstetrics, Philipps-University of Marburg, Marburg , in cooperation with the Clara Angela Foundation, Witten
,
B. Arabin
Department of Gynecology and Obstetrics, Philipps-University of Marburg, Marburg , in cooperation with the Clara Angela Foundation, Witten
Department of Gynecology and Obstetrics, Philipps-University of Marburg, Marburg , in cooperation with the Clara Angela Foundation, Witten
› Author Affiliations
Further Information

Publication History

received 07 September 2014
revised 20 October 2014

accepted 26 October 2014

Publication Date:
26 November 2014 (online)

Abstract

Objective: Patients with a history of one or more conizations have an increased risk of spontaneous preterm birth (SPTB). The aim of this study was to investigate the outcome of pregnancies in patients with a history of conization and early treatment with a cervical pessary. Methods: In this pilot observational study we included 21 patients and evaluated the obstetric history, the interval between pessary placement and delivery, gestational age at delivery, the neonatal outcome and the number of days of maternal and neonatal admission. Results: Among the study group of 21 patients, 20 patients had a singleton and one had a dichorionic/diamniotic twin pregnancy. At insertion, the mean gestational age was 17 + 2 (10 + 5–24 + 0) weeks and the mean cervical length was 19 (4–36) mm. Six patients presented with funneling at insertion with a mean funneling width of 19.7 (10–38) mm and funneling length of 19.9 (10–37) mm. Five patients had already lost at least one child due to early spontaneous preterm birth and another five had at least one previous abortion, who have now delivered beyond 34 weeks. The mean gestational age at delivery was 38 (31 + 1–41 + 0) gestational weeks and the mean interval between insertion and delivery was 145 (87–182) days. Conclusion: Our findings suggest a beneficial effect of an early pessary placement for patients at high-risk for preterm birth due to conization.

Zusammenfassung

Ziel: Schwangere Patientinnen nach Konisation haben ein erhöhtes Risiko für eine Frühgeburt. Das Ziel der vorliegenden Studie war die prospektive Beobachtung einer Kohorte von Schwangerschaften nach einer oder mehreren Konisationen und früher Behandlung mit einem zervikalen Pessar. Methoden: In dieser Pilotstudie wurden insgesamt 21 Patientinnen rekrutiert. Es wurden die geburtshilfliche Anamnese, die Zervixlänge und die Zervixstruktur (Funneling) mithilfe transvaginaler Sonografie, die Prolongation der Schwangerschaft, das Gestationsalter bei der Entbindung, sowie das neonatale Outcome und die Tage des Aufenthalts von Müttern und Kindern erfasst. Ergebnisse: Das Kollektiv umfasste 21 Patientinnen, 20 Patientinnen hatten eine Einlings- und 1 Patientin hatte eine dichoriale/diamniale Zwillingsschwangerschaft. Beim Einlegen des Pessars betrug das mittlere Gestationsalter 17 + 2 (10 + 5–24 + 0) Schwangerschaftswochen (SSW) und die mittlere Zervixlänge 19 (4–36) mm. Sechs Patientinnen zeigten eine Trichterbildung bereits beim Einlegen des Pessars mit einer mittleren Breite von 19,7 (10–38) mm und einer mittleren Länge von 19,9 (10–37) mm. Fünf Patientinnen hatten bereits ein Kind aufgrund von Frühgeburtlichkeit verloren und 5 weitere Patientinnen hatten mindestens eine Fehlgeburt in der Anamnese, welche in der aktuellen Schwangerschaft nach der 34. SSW entbunden haben. Das mittlere Gestationsalter bei Entbindung war 38 (31 + 1–41 + 0) SSW und die mittlere Zeit zwischen Einlegen des Pessars und Entbindung betrug 145 (87–182) Tage. Schlussfolgerung: Unsere Ergebnisse zeigten einen nützlichen Effekt der frühzeitigen Behandlung mit Pessar für Risikoschwangerschaften nach Konisation.

 
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