akusherstvoObstetrics, Gynecology and ReproductionАкушерство, Гинекология и Репродукция2313-73472500-3194IRBIS LLC10.17749/2313-7347.2016.10.2.064-069akusherstvo-295Research ArticleREVIEW ARTICLEНАУЧНЫЙ ОБЗОРMANAGEMENT OF PATIENTS WITH CERVICAL INSUFFICIENCYВЕДЕНИЕ ПАЦИЕНТОК С ИСТМИКО-ЦЕРВИКАЛЬНОЙ НЕДОСТАТОЧНОСТЬЮЛеваковС. А.LevakovS. A.

д.м.н., профессор, заведующий кафедрой акушерства и гинекологии ИПО,

ул. Трубецкая, 8, стр. 2, Москва, 119048

MD, Professor, Head of the Department of Obstetrics and Gynecology IPO,

ul. Trubetskaya, 8, p. 2, Moscow, 119048

Levakoff@yandex.ruБоровковаЕ. И.BorovkovaE. I.

д.м.н., профессор кафедры акушерства и гинекологии ИПО,

ул. Трубецкая, 8, стр. 2, Москва, Россия, 119048

MD, Professor, Department of Obstetrics and Gynecology IPO,

ul. Trubetskaya, 8, p. 2, Moscow, 119048

Katyanikitina@mail.ruШешуковаН. А.SheshukovaN. A.

д.м.н., профессор кафедры акушерства и гинекологии ИПО,

ул. Трубецкая, 8, стр. 2, Москва, 119048

MD, Professor, Department of Obstetrics and Gynecology IPO,

ul. Trubetskaya, 8, p. 2, Moscow, 119048

dr.sheshukova@mail.ruБоровковИ. М.BorovkovI. M.

студент,

ул. Трубецкая, 8, стр. 2, Москва, 119048

student,

ul. Trubetskaya, 8, p. 2, Moscow, 119048

bigchanc97@gmail.comГБОУ ВПО «Первый МГМУ имени И.М. Сеченова» Минздрава РоссииРоссияFirst Moscow State Medical Sechenov University of the Ministry of Health Russian FederationRussian Federation2016020920161026469Copyright © Levakov S.A., Borovkova E.I., Sheshukova N.A., Borovkov I.M., 20162016Леваков С.А., Боровкова Е.И., Шешукова Н.А., Боровков И.М.Levakov S.A., Borovkova E.I., Sheshukova N.A., Borovkov I.M.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.gynecology.su/jour/article/view/295

The article presents a literature review on methods of diagnosis, therapy and management of patients with isthmic-cervical insufficiency. Risk factors for the development of isthmic-cervical insufficiency are the acquired and congenital anomalies of the cervix. The diagnosis can be made only during pregnancy. Shortening of cervical length <25 mm before 24 weeks indicates the presence of ICN and the significant risk of miscarriage. Initial evaluation of the cervical length is from 14 weeks. When finding a shortening of the length of the closed part of the cervical canal is less than 25 mm the treatment of choice is surgical correction. When the cervical length more than 25 mm prophylactically from 19 to 32 weeks assigned to micronized progesterone 200 mg vagina. In identifying ICN after 24 weeks, the method of choice is the appointment of micronized progesterone and the installation of an unloading obstetric pessary. The use of a differentiated algorithm of management of patients with ICN reduces the chance of unexpected premature birth and neonatal morbidity and mortality.

В статье представлен обзор литературы, посвященный методам диагностики, терапии и тактики ведения пациенток с истмико-цервикальной недостаточностью (ИЦН). Факторами риска развития истмико-цервикальной недостаточности являются приобретенные и врожденные аномалии шейки матки. Диагноз может быть поставлен только во время беременности. Укорочение длины шейки матки <25 мм до 24 нед. свидетельствует о наличии ИЦН и значимом риске невынашивания беременности. Первичная оценка длины шейки матки проводится с 14 нед. При выявлении укорочения длины сомкнутой части цервикального канала менее 25 мм методом выбора является хирургическая коррекция и вагинальный прогестерон. При выявлении ИЦН в сроки после 24 нед. методом выбора является назначение микронизированного прогестерона и установка разгрузочного акушерского пессария. Применение дифференцированного алгоритма ведения пациенток с ИЦН снижает вероятность неожиданных преждевременных родов и неонатальной заболеваемости и смертности.

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The authors declare that there are no conflicts of interest present.