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[Cervical incompetence in multifetal gestation: diagnosis and prophylaxis]
Alexander Strauss1, Susanne Müller-Egloff, Ivo Markus Heer
1Klinik und Poliklinik für Frauenheilkunde und Geburtshilfe - Grosshadern, Klinikum der Universität München, Munich, Germany. Alexander.Strauss@gyn.med.uni-muenchen.de
Gynakologisch-Geburtshilfliche Rundschau
|March 22, 2003
Summary
Early detection of cervical incompetence in multiple pregnancies using ultrasound is key. Prophylactic cervical cerclage does not improve pregnancy outcomes or prolong gestation in these high-risk cases.
Area of Science:
- Maternal-Fetal Medicine
- Diagnostic Imaging
- Perinatology
Background:
- Preterm birth in multiple gestation pregnancies is a significant concern, often linked to cervical incompetence.
- Early detection and management strategies are crucial for improving perinatal outcomes in high-risk pregnancies.
Purpose of the Study:
- To validate a sonographic system for early detection of cervical incompetence in multifetal pregnancies.
- To assess the impact of prophylactic cervical cerclage on pregnancy management and perinatal outcomes in multiple gestations.
Main Methods:
- Comparison of multifetal pregnancies monitored with 3D ultrasound and those treated with cervical cerclage against control groups.
- Utilized cervical volumetry and 2D cervical length measurements via ultrasound.
Main Results:
- 3D ultrasound enabled successful cervical volumetry in all cases.
- A significant correlation was observed between 2D cervical length and cervical volume, both decreasing with gestational age.
- Prophylactic cervical cerclage did not prolong pregnancies or improve hospitalization, tocolysis, or perinatal outcomes compared to controls.
Conclusions:
- Prophylactic cervical cerclage shows no positive impact on the course or outcome of multifetal pregnancies.
- Early, non-invasive sonographic diagnosis of cervical incompetence allows for risk-adapted, conservative pregnancy management.