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Treatment of ischemic-cervical insufficiency outside of pregnancy

 
, medical expert
Last reviewed: 19.10.2021
 
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If there is an ischemic-cervical insufficiency, the treatment should be etiological. Thus, with gross anatomical changes in the cervix due to old ruptures (if this is the only reason for miscarriage), surgical treatment outside of pregnancy (cervical plastic) is necessary.

Prior to surgical treatment, a thorough bacteriological study and prophylactic antibacterial treatment are necessary, since with ischemic-cervical insufficiency, in most cases the uterine cavity is infected due to the absence of the blocking function of the cervical ystic region.

For the first time outside of pregnancy, an operation on the cervix for Isthmiko-cervical insufficiency was suggested by Lasha et al. (1950). The operation consists in excision of the oval tissue flap in order to remove scar tissue at the fracture site in order to restore the fibrous-muscular integrity of the cervix.

At present, several modifications of the Lash method are known.

The original method of reconstructive-plastic surgery on the cervix was suggested by V.I. Eltsov-Strelkov and co-authors (1979). The operation consists of five stages:

  • dissection of the cervix,
  • stratification of the cervix,
  • formation of the cervical canal,
  • formation of an external throat,
  • the final formation of the cervix.

At the onset of pregnancy after plastic surgery on the cervix, it is advisable to give birth by cesarean section.

With functional ischemic-cervical insufficiency or anatomical, but not requiring reconstructive surgery, the first stage of preparation for the next pregnancy is a thorough bacteriological study and antibacterial therapy taking into account the pathogen during 2-3 menstrual cycles in combination with physiotherapy. After this, immunological and hormonal control and pathogenetic therapy are necessary, taking into account the obtained data. Hormonal preparation is the final stage of treatment before pregnancy. Surgical surgery for ishmiko-cervical insufficiency is carried out during pregnancy.

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