Desafíos en la prevención del parto prematuro asociado con la insuficiencia cervical.
DOI:
https://doi.org/10.5327/JBG-2965-3711-2024134103%20Palabras clave:
cerclagem cervical, incompetência do colo do útero, pessário, progesteronaResumen
Introdução: A insuficiência cervical é um importante fator de risco de prematuridade, principal causa de morbidade e mortalidade perinatais. Objetivo: Revisar critérios diagnósticos e estratégias para reduzir partos pré-termos associados à insuficiência cervical. Métodos: Revisão bibliográfica dos últimos cinco anos (2018–2023), nas bases de dados Pubmed e Biblioteca Virtual em Saúde, usando descritores relacionados à insuficiência cervical. Foram consideradas revisões sistemáticas e metanálises, e guidelines. Resultados: Foram incluídos 69 artigos. A insuficiência cervical tem critérios diagnósticos pouco claros. As evidências atuais orientam que seu diagnóstico pode ser obtido através da história obstétrica sugestiva, da identificação de colo curto (≤25 mm) por meio de ultrassom, ou colo dilatado na ausência de trabalho de parto na gestação atual. Em mulheres com história sugestiva de insuficiência cervical, é indicada cerclagem eletiva. Em gestações únicas submetidas à vigilância por ultrassom do comprimento cervical entre 160/7 e 246/7 semanas, deve ser oferecida cerclagem para colo curto. Em gestação única, a progesterona está indicada na história de parto pré-termo espontâneo, ou quando observado colo curto no ultrassom transvaginal mesmo sem história de parto pré-termo anterior. Em pacientes de risco habitual, a medida de colo uterino é indicada entre 18 e 24 semanas de gestação, durante o ultrassom morfológico de segundo trimestre. Não há evidências suficientes que suportem o uso do pessário para prevenção de parto pré-termo. Em gestações gemelares não selecionadas, não há evidências para uso de progesterona ou cerclagem cervical para redução de parto pré-termo. Conclusão: A decisão sobre a melhor forma de minimizar o risco de perda gestacional associada à insuficiência cervical deve ser individualizada, considerando a história obstétrica, o encurtamento (ou dilatação) cervical, a experiência da equipe assistencial e o consentimento da gestante.
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American College of Obstetricians and Gynecologists' Committee on Practice Bulletins. Prediction and Prevention of Spontaneous Preterm Birth: ACOG Practice Bulletin, Number 234. Obstet Gynecol. 2021;138(2):e65-e90. https://doi.org/10.1097/aog.0000000000004479
Diacci RC, Issah A, Williams KP, McAuliffe L, Aubin AM, McAuliffe JE, et al. Effectiveness of combined vaginal progesterone and cervical cerclage in preventing preterm birth: a systematic review and meta-analysis protocol. BMJ Open. 2021;11(6):e050086. https://doi.org/10.1136/bmjopen-2021-050086
Coutinho CM, Sotiriadis A, Odibo A, Khalil A, D'Antonio F, Feltovich H, et al. ISUOG Practice Guidelines: role of ultrasound in the prediction of spontaneous preterm birth. Ultrasound Obstet Gynecol. 2022;60(3):435-56. https://doi.org/10.1002/uog.26020
Abdel-Aleem H, Shaaban OM, Abdel-Aleem MA, Aboelfadle Mohamed A. Cervical pessary for preventing preterm birth in singleton pregnancies. Cochrane Database Syst Rev. 2022;(12):CD014508. https://doi.org/10.1002/14651858.cd014508
Kabiri D, Hamou Y, Gordon G, Ezra Y, Matok I. Comparing the efficacy of vaginal micronized progesterone gel and capsule for prevention of preterm birth in singleton pregnancies with short cervical length at midtrimester: an indirect comparison meta-analysis. Front Pharmacol. 2023;14:1153013. https://doi.org/10.3389/fphar.2023.1153013
Putora K, Hornung R, Kinkel J, Fischer T, Putora PM. Progesterone, cervical cerclage or cervical pessary to prevent preterm birth: a decision-making analysis of international guidelines. BMC Pregnancy Childbirth. 2022;22(1):355. https://doi.org/10.1186/s12884-022-04584-4
Brasil. Ministério da Saúde. Secretaria de Atenção Primária à Saúde. Departamento de Ações Programáticas. Manual de gestação de alto risco [Internet]. Brasília: Ministério da Saúde; 2022 [acessado em 1º dez. 2022]. Disponível em: https://bvsms.saude.gov.br/bvs/publicacoes/manual_gestacao_alto_risco.pdf
Shennan AH, Story L, Royal College of Obstetricians, Gynaecologists. Cervical Cerclage: Green-top Guideline No. 75. BJOG. 2022;129(7):1178-210. https://doi.org/10.1111/1471-0528.17003
Care A, Nevitt SJ, Medley N, Donegan S, Good L, Hampson L, et al. Interventions to prevent spontaneous preterm birth in women with singleton pregnancy who are at high risk: systematic review and network meta-analysis. BMJ. 2022;376:e064547. https://doi.org/10.1136/bmj-2021-064547
D'Antonio F, Berghella V, Di Mascio D, Saccone G, Sileo F, Flacco ME, et al. Role of progesterone, cerclage and pessary in preventing preterm birth in twin pregnancies: A systematic review and network meta-analysis. Eur J Obstet Gynecol Reprod Biol. 2021;261:166-77. https://doi.org/10.1016/j.ejogrb.2021.04.023
Brown R, Gagnon R, Delisle MF. No. 373-Cervical Insufficiency and Cervical Cerclage. J Obstet Gynaecol Can. 2019;41(2):233-47. https://doi.org/10.1016/j.jogc.2018.08.009
Brittain JJ, Wahl SE, Strauss JF 3rd, Romero R, Wolf HM, Murphy K, et al. Prior Spontaneous or Induced Abortion Is a Risk Factor for Cervical Dysfunction in Pregnant Women: a Systematic Review and Meta‐analysis. Reprod Sci. 2023;30(7):2025-39. https://doi.org/10.1007/s43032-023-01170-7
Eke AC, Sheffield J, Graham EM. Adjuvant 17-hydroxyprogesterone caproate in women with history-indicated cerclage: A systematic review and meta-analysis. Acta Obstet Gynecol Scand. 2019;98(2):139-53. https://doi.org/10.1111/aogs.13488
Bortoletto TG, Borovac-Pinheiro A, França MS, Pacagnella RC. Comprimento de colo uterino ao ultrassom transvaginal como preditor de risco do parto pré-termo espontâneo / Ultrasound cervical lenght predicting risk for spontaneous preterm birth. Femina. 2020;48(7):432-8.
Lim KI, Butt K, Nevo O, Crane JM. Guideline No. 401: Sonographic Cervical Length in Singleton Pregnancies: Techniques and Clinical Applications. J Obstet Gynaecol Can. 2020;42(11):1394-413.e1. https://doi.org/10.1016/j.jogc.2019.06.002
Berghella V, Saccone G. Cervical assessment by ultrasound for preventing preterm delivery. Cochrane Database Syst Rev. 2019;(9):CD007235. https://doi.org/10.1002/14651858.cd007235.pub4
Romero R, Conde-Agudelo A, Nicolaides KH. There is insufficient evidence to claim that cerclage is the treatment of choice for patients with a cervical length <10 mm. Am J Obstet Gynecol. 2018;219(2):213-5. https://doi.org/10.1016/j.ajog.2018.04.009
Campbell F, Salam S, Sutton A, Jayasooriya SM, Mitchell C, Amabebe E ,et al. Interventions for the prevention of spontaneous preterm birth: a scoping review of systematic reviews. BMJ Open 2022;12(5):e052576. https://doi.org/10.1136/bmjopen-2021-052576
Jarde A, Lutsiv O, Beyene J, McDonald SD. Vaginal progesterone, oral progesterone, 17-OHPC, cerclage, and pessary for preventing preterm birth in at-risk singleton pregnancies: an updated systematic review and network meta-analysis. BJOG. 2019;126(5):556-67. https://doi.org/10.1111/1471-0528.15566
Medley N, Vogel JP, Care A, Alfirevic Z. Interventions during pregnancy to prevent preterm birth: an overview of Cochrane systematic reviews. Cochrane Database Syst Rev. 2018;(11):CD012505. https://doi.org/10.1002/14651858.cd012505.pub2
Phung J, Williams KP, McAullife L, Martin WN, Flint C, Andrew B, et al. Vaginal progesterone for prevention of preterm birth in asymptomatic high-risk women with a normal cervical length: a systematic review and meta-analysis. J Matern Fetal Neonatal Med. 2022;35(25):7093-101. https://doi.org/10.1080/14767058.2021.1943657
Aubin AM, McAuliffe L, Williams K, Issah A, Diacci R, McAuliffe JE, et al. Combined vaginal progesterone and cervical cerclage in the prevention of preterm birth: a systematic review and meta-analysis. Am J Obstet Gynecol MFM. 2023;5(8):101024. https://doi.org/10.1016/j.ajogmf.2023.101024
Gulersen M, Lenchner E, Nicolaides KH, Otsuki K, Rust OA, Althuisius S, et al. Cervical cerclage for short cervix at 24 to 26 weeks of gestation: systematic review and meta-analysis of randomized controlled trials using individual patient-level data. Am J Obstet Gynecol MFM. 2023;5(6):100930. https://doi.org/10.1016/j.ajogmf.2023.100930
Pilarski N, Hodgetts-Morton V, Morris RK. Is cerclage safe and effective in preventing preterm birth in women presenting early in pregnancy with cervical dilatation? BMJ. 2021;375:e067470. https://doi.org/10.1136/bmj-2021-067470
Chatzakis C, Efthymiou A, Sotiriadis A, Makrydimas G. Emergency cerclage in singleton pregnancies with painless cervical dilatation: A meta-analysis. Acta Obstet Gynecol Scand. 2020;99(11):1444-57. https://doi.org/10.1111/aogs.13968
Hulshoff CC, Bosgraaf RP, Spaanderman MEA, Inthout J, Scholten RR, Van Drongelen J. The efficacy of emergency cervical cerclage in singleton and twin pregnancies: a systematic review with meta-analysis. Am J Obstet Gynecol MFM. 2023;5(7):100971. https://doi.org/10.1016/j.ajogmf.2023.100971
Li C, Hua K. Efficacy of physical examination-indicated cerclage in twin pregnancies compared with singleton pregnancies: a systematic review and meta-analysis. Minerva Obstet Gynecol. 2021;73(1):111-20. https://doi.org/10.23736/s2724-606x.20.04518-9
Wei Y, Wang S. Comparison of emergency cervical cerclage and expectant treatment in cervical insufficiency in singleton pregnancy: A meta-analysis. PLoS One. 2023;18(2):e0278342. https://doi.org/10.1371/journal.pone.0278342
Grabovac M, Lewis-Mikhael AM, McDonald SD. Interventions to Try to Prevent Preterm Birth in Women With a History of Conization: A Systematic Review and Meta-analyses. J Obstet Gynaecol Can. 2019;41(1):76-88.e7. https://doi.org/10.1016/j.jogc.2018.04.026
Wang T, Jiang R, Yao Y, Huang X. Can prophylactic transvaginal cervical cerclage improve pregnancy outcome in patients receiving cervical conization? A meta-analysis. Ginekol Pol. 2021;92(10):704-13. https://doi.org/10.5603/gp.a2021.0020
Bruno AM, Benson AE, Metz TD, Blue NR. Adjunct Therapy at Time of Examination-Indicated Cervical Cerclage in Singleton Pregnancies: A Systematic Review and Meta-analysis. Am J Perinatol. 2022;39(16):1719-25. https://doi.org/10.1055/a-1877-9078
Eleje GU, Eke AC, Ikechebelu JI, Ezebialu IU, Okam PC, Ilika CP. Cervical stitch (cerclage) in combination with other treatments for preventing spontaneous preterm birth in singleton pregnancies. Cochrane Database Syst Rev. 2020;(9):CD012871. https://doi.org/10.1002/14651858.cd012871.pub2
van Dijk CE, Breuking SH, Jansen S, Limpens JCEJM, Kazemier BM, Pajkrt E. Perioperative complications of a transvaginal cervical cerclage in singleton pregnancies: a systematic review and meta-analysis. Am J Obstet Gynecol. 2023;228(5):521-34.e19. https://doi.org/10.1016/j.ajog.2022.10.026
Alani S, Wang J, Suarthana E, Tulandi T. Complications associated with cervical cerclage: A systematic review. Gynecol Minim Invasive Ther. 2023;12(1):4-9. https://doi.org/10.4103/gmit.gmit_61_22
Hessami K, Kyvernitakis I, Cozzolino M, Moisidis-Tesch C. McDonald versus Shirodkar cervical cerclage for prevention of preterm birth: a systematic review and meta-analysis of pregnancy outcomes. J Matern Fetal Neonatal Med. 2022;35(25):6510-7. https://doi.org/10.1080/14767058.2021.1916911
McAuliffe L, Issah A, Diacci R, Williams KP, Aubin AM, Phung J, et al. McDonald versus Shirodkar cerclage technique in the prevention of preterm birth: A systematic review and meta-analysis. BJOG. 2023;130(7):702-12. https://doi.org/10.1111/1471-0528.17438
Marchand G, Taher Masoud A, Azadi A, Govindan M, Ware K, King A, et al. Efficacy of laparoscopic and trans-abdominal cerclage (TAC) in patients with cervical insufficiency: A systematic review and meta-analysis. Eur J Obstet Gynecol Reprod Biol. 2022;270:111-25. https://doi.org/10.1016/j.ejogrb.2022.01.002
Marchand GJ, Masoud AT, Galitsky A, Sainz K, Azadi A, Ware K, et al. Complications of Laparoscopic and Transabdominal Cerclage in Patients with Cervical Insufficiency: A Systematic Review and Meta-analysis. J Minim Invasive Gynecol. 2021;28(4):759-68.e2. https://doi.org/10.1016/j.jmig.2020.11.014
Senarath S, Ades A, Nanayakkara P. Cervical Cerclage: A Review and Rethinking of Current Practice. Obstet Gynecol Surv. 2020;75(12):757-65. https://doi.org/10.1097/ogx.0000000000000847
Society for Maternal-Fetal Medicine (SMFM); Temming L, Mikhail E; SMFM Publications Committee. Society for Maternal-Fetal Medicine Consult Series #65: Transabdominal cerclage. Am J Obstet Gynecol. 2023;228(6):B2-B10. https://doi.org/10.1016/j.ajog.2023.02.018
Iavazzo C, Minis EE, Gkegkes ID. Robotic assisted laparoscopic cerclage: A systematic review. Int J Med Robot. 2019;15(1):e1966. https://doi.org/10.1002/rcs.1966
Feng J, Wei S, Pang L. Mersilene tape versus conventional sutures in transvaginal cervical cerclage: a systematic review and meta-analysis. BMC Pregnancy Childbirth. 2023;23(1):819. https://doi.org/10.1186/s12884-023-06141-z
Zullo F, Di Mascio D, Chauhan SP, Chrysostomou S, Suff N, Pecorini F, et al. Removal versus retention of cervical cerclage with preterm prelabor rupture of membranes: Systematic review and meta-analysis. Eur J Obstet Gynecol Reprod Biol. 2023;288:83-9. https://doi.org/10.1016/j.ejogrb.2023.07.006
D'Antonio F, Eltaweel N, Prasad S, Flacco ME, Manzoli L, Khalil A. Cervical cerclage for prevention of preterm birth and adverse perinatal outcome in twin pregnancies with short cervical length or cervical dilatation: A systematic review and meta-analysis. PLoS Med. 2023;20(8):e1004266. https://doi.org/10.1371/journal.pmed.1004266
Liu Y, Chen M, Cao T, Zeng S, Chen R, Liu X. Cervical cerclage in twin pregnancies: An updated systematic review and meta-analysis. Eur J Obstet Gynecol Reprod Biol. 2021;260:137-49. https://doi.org/10.1016/j.ejogrb.2021.03.013
Li C, Shen J, Hua K. Cerclage for women with twin pregnancies: a systematic review and metaanalysis. Am J Obstet Gynecol. 2019;220(6):543-57.e1. https://doi.org/10.1016/j.ajog.2018.11.1105
Su J, Li D, Yang Y, Cao Y, Yin Z. Cerclage placement in twin pregnancies with cervical dilation: a systematic review and meta-analysis. J Matern Fetal Neonatal Med. 2022;35(25):9112-8. https://doi.org/10.1080/14767058.2021.2015577
Shennan A, Suff N, Leigh Simpson J, Jacobsson B, Mol BW, Grobman WA; FIGO Working Group for Preterm Birth. FIGO good practice recommendations on progestogens for prevention of preterm delivery. Int J Gynaecol Obstet. 2021;155(1):16-8. https://doi.org/10.1002/ijgo.13852
Wennerholm UB, Bergman L, Kuusela P, Ljungström E, Möller AC, Hongslo Vala C, et al. Progesterone, cerclage, pessary, or acetylsalicylic acid for prevention of preterm birth in singleton and multifetal pregnancies: A systematic review and meta-analyses. Front Med (Lausanne). 2023;10:1111315. https://doi.org/10.3389/fmed.2023.1111315
Alsulmi ES, Alfaraj M, Faden Y, Al Qahtani N. The use of progesterone during pregnancy to prevent preterm birth. Saudi Med J. 2020;41(4):333-40. https://doi.org/10.15537/smj.2020.4.25036
Romero R, Conde-Agudelo A, Da Fonseca E, O'Brien JM, Cetingoz E, Creasy GW, et al. Vaginal progesterone for preventing preterm birth and adverse perinatal outcomes in singleton gestations with a short cervix: a meta-analysis of individual patient data. Am J Obstet Gynecol. 2018;218(2):161-80. https://doi.org/10.1016/j.ajog.2017.11.576
Dodd JM, Grivell RM, OBrien CM, Dowswell T, Deussen AR. Prenatal administration of progestogens for preventing spontaneous preterm birth in women with a multiple pregnancy. Cochrane Database Syst Rev. 2019;(11):CD012024. https://doi.org/10.1002/14651858.cd012024.pub3
EPPPIC Group. Evaluating Progestogens for Preventing Preterm birth International Collaborative (EPPPIC): meta-analysis of individual participant data from randomised controlled trials. Lancet. 2021;397(10280):1183-94. https://doi.org/10.1016/s0140-6736(21)00217-8
Boelig RC, Della Corte L, Ashoush S, McKenna D, Saccone G, Rajaram S, et al. Oral progesterone for the prevention of recurrent preterm birth: systematic review and metaanalysis. Am J Obstet Gynecol MFM. 2019;1(1):50-62. https://doi.org/10.1016/j.ajogmf.2019.03.001
Fernandez-Macias R, Martinez-Portilla RJ, Cerrillos L, Figueras F, Palacio M. A systematic review and meta-analysis of randomized controlled trials comparing 17-alpha-hydroxyprogesterone caproate versus placebo for the prevention of recurrent preterm birth. Int J Gynaecol Obstet. 2019;147(2):156-64. https://doi.org/10.1002/ijgo.12940
Jain V, McDonald SD, Mundle WR, Farine D. Guideline No. 398: Progesterone for Prevention of Spontaneous Preterm Birth. J Obstet Gynaecol Can. 2020;42(6):806-12. https://doi.org/10.1016/j.jogc.2019.04.012
Kuon RJ, Berger R, Rath W. 17-Hydroxyprogesterone Caproate for the Prevention of Recurrent Preterm Birth: A Systematic Review and Meta-analysis Taking into Account the PROLONG Trial. Geburtshilfe Frauenheilkd. 2021;81(1):61-9. https://doi.org/10.1055/a-1295-0752
Lichter KE, Sheffield J, Graham EM, Eke AC. Adjuvant 17-hydroxyprogesterone caproate in women withultrasound-indicated cerclage: a systematic review and meta-analysis. J Matern Fetal Neonatal Med. 2020;33(18):3177-84. https://doi.org/10.1080/14767058.2019.1568406
Society for Maternal-Fetal Medicine (SMFM). Society for Maternal-Fetal Medicine Statement: Response to the Food and Drug Administration's withdrawal of 17-alpha hydroxyprogesterone caproate. Am J Obstet Gynecol. 2023;229(1):B2-B6. https://doi.org/10.1016/j.ajog.2023.04.012
Williams KP, McAuliffe L, Diacci R, Aubin AM, Issah A, Wang C, et al. Vaginal progesterone for prevention of preterm birth in asymptomatic high-risk women with a normal cervical length: a systematic review and meta-analysis protocol. Syst Rev. 2021;10(1):152. https://doi.org/10.1186/s13643-021-01702-9
Corrêa TD, Amorim EG, Tomazelli JAG, Corrêa MD Júnior. Use of the pessary in the prevention of preterm delivery. Rev Bras Ginecol Obstet. 2019;41(1):53-8. https://doi.org/10.1055/s-0038-1676511
Jin Z, Chen L, Qiao D, Tiwari A, Jaunky CD, Sun B, et al. Cervical pessary for preventing preterm birth: a meta-analysis. J Matern Fetal Neonatal Med. 2019;32(7):1148-54. https://doi.org/10.1080/14767058.2017.1401998
Pérez-López FR, Chedraui P, Pérez-Roncero GR, Martínez-Domínguez SJ; Health Outcomes and Systematic Analyses (HOUSSAY) Project. Effectiveness of the cervical pessary for the prevention of preterm birth in singleton pregnancies with a short cervix: a meta-analysis of randomized trials. Arch Gynecol Obstet. 2019;299(5):1215-31. https://doi.org/10.1007/s00404-019-05096-x
Zheng L, Dong J, Dai Y, Zhang Y, Shi L, Wei M, et al. Cervical pessaries for the prevention of preterm birth: a systematic review and meta-analysis. J Matern Fetal Neonatal Med. 2019;32(10):1654-63. https://doi.org/10.1080/14767058.2017.1414795
Zhuang Y, Li H, Na Q, Yin S, Li N. Prevention of Preterm Birth by Cervical Pessary Combined with Vaginal Progesterone: a Systematic Review and Meta-analysis with Trial Sequential Analysis. Reprod Sci. 2023;30(1):93-110. https://doi.org/10.1007/s43032-022-00926-x
Conde-Agudelo A, Romero R, Nicolaides KH. Cervical pessary to prevent preterm birth in asymptomatic high- risk women: a systematic review and meta-analysis. Am J Obstet Gynecol. 2020;223(1):42-65.e2. https://doi.org/10.1016/j.ajog.2019.12.266
Liu J, Song G, Meng T, Zhao G. Vaginal progesterone combined with cervical pessary in preventing preterm birth: a meta-analysis. J Matern Fetal Neonatal Med. 2021;34(18):3050-6. https://doi.org/10.1080/14767058.2019.1677596
Thangatorai R, Lim FC, Nalliah S. Cervical pessary in the prevention of preterm births in multiple pregnancies with a short cervix: PRISMA compliant systematic review and meta-analysis. J Matern Fetal Neonatal Med. 2018;31(12):1638-45. https://doi.org/10.1080/14767058.2017.1319930
Xiong YQ, Tan J, Liu YM, Qi YN, He Q, Li L, et al. Cervical pessary for preventing preterm birth in singletons and twin pregnancies: an update systematic review and meta-analysis. J Matern Fetal Neonatal Med. 2022;35(1):100-9. https://doi.org/10.1080/14767058.2020.1712705
