PrematureLabour and Cervical Incompetence

Overview

Objective:
To evaluate the risk of preterm delivery in pregnant women with cervical incompetence.Design: Prospective international multicentric randomized clinical study.Setting: Department of Obstetrics and Gynaecology, Palacký University Medical School and University Hospital, Olomouc.Methods: As a part of a prospective randomized international study CIPRACT (Cervical Incompetence Prevention Randomized Cerclage Trial) a group of 112 patients at risk for preterm deliveryhas been evaluated. Our study group included 22 women with the history of a previous pretermdelivery, 40 women with twin pregnancy and 50 women with cervical incompetence in currentpregnancy objectively proven by vaginal sonography. All patients have been examined every twoweeks and severe cases have been hospitalized. According to the project’s study protocol 17patients were randomly allocated to the prophylactic cerclage.Results: Thirteen (59 %) patients with the history of a previous preterm delivery delivered at termand 9 (41 %) prematurely. Among patients with twin pregnancy 32 (80 %) gave birth at term, whileonly 8 (20 %) went into labour prematurely. In the group of patients with objectively provencervical incompetence in current pregnancy 42 (84 %) delivered at term and only 8 (16 %) prematurely. The difference in frequency of premature delivery in the group of patients with thehistory of a previous preterm delivery and in the group with the clinically proven cervical incometence is statistically significant at p = 0,05 (the test of the difference of two relative values, t =2,208). Four patients (23 %) with prophylactic cerclage delivered prematurely. Conclusions: In comparison with other pregnant women at risk for premature labour who havenot had clinical symptoms a significantly lower risk has been found in the group of pregnantwomen with an early diagnosed cervical incompetence. This difference is not only due to theprophylactic cerclage, but is probably related to the intensive care and an appropriate therapy.v

Key words:
premature delivery, cervical incompetence, cerclage, twin pregnancy