Reapplication of a double circular suture on the cervix during pregnancy in the presence of isthmic-cervical insufficiency

Background. The incidence of isthmic-cervical insufficiency in pregnant women is 0.8-1%, especially if there is a history of miscarriage in the second trimester of pregnancy, there is a significant increase in the numbers for the development of this pathology, reaching 20%. The most common surgical method for treating isthmic-cervical insufficiency is considered to be the application of a circular suture to the cervix according to McDonald. Due to its simplicity and effectiveness, the McDonald technique is recommended as a first-line procedure. Results. In some cases, complications arise after applying a suture to the cervix. Most often, complications such as vaginal bleeding, premature rupture of the fetal membranes, the occurrence of infectious processes inside the uterus, suture divergence and other possible complications arise after the procedure. Such problems also include eruption of the amniotic sac, and in some cases its prolapse. The issue of treating such patients remains unresolved, since there are no clear clinical recommendations. The study included 7 cases of pregnant women with isthmic-cervical insufficiency and symptoms indicating "insufficiency" or rupture of the cervical suture after previous surgical correction during pregnancy. A specially developed technique involving double circular suture application for enhanced fixation was used in all patients. Micronized progesterone was mandatory before surgical correction and after suturing was performed until the 34th week of pregnancy, and, given the increased risk of ascending infection, patients were prescribed prophylactic antibiotic therapy. After suture placement, antibiotic therapy was administered until the 34th week due to the risk of ascending infection. A secondary suture was placed in one patient at 17-18 weeks, in three other patients the procedure was performed at 20-21 weeks, and in three more women the suture was placed at 23-24 weeks of pregnancy.

Conclusion. The pregnancy outcomes of these patients were carefully analyzed. In one case, a premature birth occurred at 31-32 weeks of pregnancy, and the newborn survived safely. In the other 6 cases, the pregnancy was extended to full term. All children were born with an Apgar score exceeding 7 points. These results indicate the success of secondary suturing in pregnant women with isthmic-cervical insufficiency.

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