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Publisher: Peytchinski Publishing Ltd.
ISSN: 1312-773X (Online)
Issue: 2025, vol. 31, issue1
Subject Area: Medicine
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DOI: 10.5272/jimab.2025311.6029
Published online: 27 Febrary 2025
Review article
J of IMAB. 2025 Jan-Mar;31(1):6029-6036
STRATIFICATION OF GRAVID CERVIX SUSPENSION – A REVIEW
Katia Telbiyska1, 2
, Mariya Angelova2,
1) Selena University Specialized Hospital for Active Treatment in Obstetrics and Gynecology, Plovdiv, Bulgaria.
2) Department of Obstetrics and Gynecology, Medical Faculty, Trakia University, Stara Zagora, Bulgaria.
ABSTRACT:
Cerclage, ARABIN pessary (AP) and progesterone demonstrate stratification of invasive, mini-invasive drug-induced suspension of the gravid cervix, manage the isthmico-cervical incompetence and regulate the rate of late abortions and preterm delivery (PTD).
In singleton pregnancies, the lowest PTD rates are as follows: for AP combined with cerclage and vaginal progesterone - 44.4%, PTD <37 g.w.; for long-term tocolysis - 30.8%, PTD <36 g.w.; for transabdominal cerclage - 8%, PTD <32 g.w. For cerclage alone, the lowest PTD rate <34 g.w. is 32.4%, for cerclage with AP - 27.7%, and for cerclage with vaginal progesterone - 17%. For indicated AP, PTD is 16%, and for electively inserted one, it is 9.4%. For AP combined with vaginal progesterone, the value is 4.6%, and for vaginal progesterone alone it is 4%. In this review, the lowest PTD rate <34 g.w. reported for AP used alone in multiple pregnancies is 18.4%.
ARABIN pessary is superior or non-inferior to cerclage in incompetent cervix in singleton pregnancies because of the similarity in PTD results; however, there is evidence that its effectiveness prevails over vaginal progesterone in twin pregnancies where a non-active approach is preferred. ARABIN cerclage pessary combined with vaginal progesterone destabilizes the non-significantly prevailing effectiveness of vaginal progesterone administered alone in singleton pregnancy. AP is not included in the guidelines as a standard treatment, although research findings suggest it is likely to be implemented as a principal recommendation in the future for gravid cervix suspension, either in combination or alone.
Keywords: ARABIN pessary, cerclage, cervical incompetence, preterm delivery, progesterone, gravid cervix suspension,
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Please cite this article as: Telbiyska K, Angelova M. Stratification of Gravid Cervix Suspension – a Review. J of IMAB. 2025 Jan-Mar;31(1):6029-6036. [Crossref - 10.5272/jimab.2025311.6029]
Correspondence to: Katia Telbiyska, Selena University Specialized Hospital for Active Treatment in Obstetrics and Gynecology, Plovdiv; 80, Peshtersko shosse Str., Plovdiv Bulgaria; E-mail: dr_k.telbiyska@mail.bg
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Received: 15 August 2024
Published online: 27 February 2025