27.1. PREGNANCY-PRESERVING SURGICAL PROCEDURES
Pregnancy-preserving surgery is aimed at surgical correction of anatomical malformations that promote miscarriage.
27.1.1. Epidemiology
The rate of structural alterations of cervix in patients with recurrent miscarriage requiring surgery is 10-16%. Structural causes of recurrent miscarriage include cervical insufficiency which is recognized as the most common cause of miscarriage in the second trimester (see Section 21.1.4.2).
Pregnancy-preserving surgery can be performed both during and outside of pregnancy. Its objective is eliminating structural causes of miscarriage.
27.1.2. Classification
All surgeries aimed at treating structural cervical insufficiency are divided into:
• those performed in pregnancy:
• surgery on the internal os (cervical cerclage);
• surgery on vaginal part of cervix;
• surgery closing the external os (no longer performed nowadays);
• those performed outside of pregnancy:
• plastic surgery on the cervix.
27.1.3. Surgical treatment
Indications for surgical treatment of cervical incompetence:
• spontaneous abortion in the second trimester and preterm delivery in past history;
• progressing cervical incompetence (findings of clinical examination): altered cervical consistency, shortened cervix (ultrasound findings), gradual dilation of cervical canal and internal os.
Prerequisites for surgical treatment of cervical incompetence in pregnancy:
• gestational age 12-16 weeks;
• no fetal malformations;
• intact gestational sac;
• normal uterine tone;
• o genital inflammation, normal vaginal flora;
• no severe somatic disease or severe complications of pregnancy;