FORMATIONS (Abstract): Cervical incompetence is basically a cervix that is too weak to ... Aim: To estimate the incidence of incompetence of the uterine cervix.
Rev. Med. Chir. Soc. Med. Nat., Iaşi – 2012 – vol. 116, no. 4
SURGERY
ORIGINAL PAPERS
CERVICAL INCOMPETENCE ASSOCIATED WITH CONGENITAL UTERINE MALFORMATIONS Maria Chifan1, Mihaela Tîrnovanu2 , Mihaela Grigore2, C. Zanoschi2 1. Municipal Hospital of Radauti, Suceava County University of Medicine and Pharmacy “Grigore T. Popa” – Iasi Faculty of Medicine 2. Discipline of Obstetrics and Gynecology CERVICAL INCOMPETENCE ASSOCIATED WITH CONGENITAL UTERINE MALFORMATIONS (Abstract): Cervical incompetence is basically a cervix that is too weak to stay closed during a pregnancy. It is generally categorized as premature opening of the cervix without labor or contractions. Aim: To estimate the incidence of incompetence of the uterine cervix at patients with congenital uterine malformations. Material and methods: Our study was a retrospective and prospective one between 2002 and 2009. We evaluate the length of the cervix by transvaginal ultrasonography during the second trimester of pregnancy. Results: We had 316 cases with congenital uterine malformations. From these we found 49 (15.3%) women with incompetence of the cervix: 8 (2.5%) with unicornuate uterus, 11 (3.4%) with bicornuate uterus and 30 (9.5%) cases uterus with septum. For all these wad made cerclage when we found funneling of the cervix or the cervix was open less than 4 cm. The use of ultrason ography has been very helpful with the diagnosis, and is made when the cervical os (opening) is greater than 2.5 cm, or the length has shortened to less than 20 mm. All patients had preterm delivery. Conclusions: When we have cases with congenital uterine malformations we must think that incompetence of the cervix could be associated, so we must assess the status of the cervix for these p atients by serial ultrasound examinations starting between 16 and 20 weeks of gestation. Our patients had preterm delivery caused not only the incompetent cervix, but the malformation of the uterus is implicated also. Keywords: CERVICAL INCOMPETENCE, CONGENITAL ULTRASONOGRAPHY, GESTATION.
Cervical incompetence is related with 15 - 20% of abortions appeared in the second quarter of pregnancy. The incidence of congenital uterine malformations (Cg.UM) in the general population and among women with recurrent pregnancy loss is not clearly known. Although the reported incidence is 0.16 to 10%, recent data suggest that it is 1% in the general population and 3% in women with recurrent pregnancy loss and adverse reproduc-
tive outcome (1, 2). Cervical incompetence (CI) due to Cg.UM has as a consequence premature birth which in turn is associated with 75% of perinatal morbidity and mortality. Two thirds of premature infants are the result of labors between 26 and 32 weeks of pregnancy and are marked by the highest rate of mortality, respiratory distress, intraventricular hemorrhage, necrotizing enterocolitis, developmental delay, visual and
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hearing deficit and chronic lung diseases (1). Effective methods for detecting preterm birth can avoid unnecessary interventions and treatments in women without risk (2). It is well-known the necessity of a suitable cervical length in order to maintain a normal pregnancy, and length and diameter of the cervix must remain steadily as pregnancy progresses, both in primiparous and multiparous. In women with low risk, cervical length (CL) is 35-40 mm at 40 weeks of pregnancy; the lower limit is 25 mm and 50 mm the higher. Hibbard (cit. 2) detected the presence of a CL of 38.5 + 8 mm at 20 weeks of pregnancy. The progressive shortening of CL occurs naturally after 30 weeks in normal full term pregnancy patients (3). A length less than 25 mm is abnormal before 24 weeks, with a risk of premature birth under 35 weeks of 4% in low-risk population and a positive predictive value (PPV) of 18%, but for pregnant women at high risk, the incidence of premature birth increases to 26% and PPV to 55% (4).
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MATERIAL AND METHODS The study consisted of 49 cases with a lot cervical incompetence (CI) selected from 316 patients with congenital uterine malformations (Cg. UM) and assisted Municipal Hospital, Radauti, Suceava County, during 2002-2009. This subset analysis showed a rural origin for 31 (63.3%) cases as compared with urban, 18 (37.7%); with occupational relationship represented by 41 (83.6%) patients employees, 7 (14.3%) households and 1 (2.1%) other categories. Age group 25-33 years represented 31 (63.3%) of total cases (fig. 1). Distribution by age groups in relation to birth type indicated a significantly higher frequency (p
