Comparative Evaluation of the Effectiveness of the Combined Method of Correction of Isthmic-cervical Insufficiency Using Dr. Arabin’s Perforated Silicone Obstetric Pessary with the Addition of Vaginal and Sublingual Tableted Micronized Progesterone

Aim: Data on the effectiveness of the combined method of correction of cervical insufficiency (CI) with the application of a pessary and the intake of micronized progesterone are innumerable and superbly. Individual studies are devoted to the study of the use of sublingual form of micronized progesterone in CN. The purpose of the study was a comparative assessment of the effectiveness of a combined therapeutic and prophylactic method for correcting CI by using Dr. Arabin’s vaginal perforated obstetric pessary and various forms of tableted micronized progesterone – vaginal and sublingual.

Material and methods: 215 pregnant women with CI were under observation. The main group included 129 pregnant women with CI, in whom therapeutic and preventive measures included a combination of applying an obstetric perforated pessary by Dr. Arabin and taking a sublingual form of micronized progesterone 100 mg three times a day up to 36 weeks of pregnancy. The replenishment included 86 pregnant women treated with CI with Dr. Arabin’s vaginal perforated obstetric pessary and micronized progesterone vaginal tablets 200 mg twice daily up to 36 weeks’ gestation. All women during the gestational period also received vitamin-mineral complexes for pregnant women, ω3-polyunsaturated fatty acids and magnesium preparations. It was aassessed course of pregnancy, obstetric and perinatal consequences.

Results: The study of further combined methods in the correction of CI led to similar results in vagity and fluctuations: there was no statistically significant difference between the main group and the group in the frequency of early opening of the fruit membranes (χ² = 6.65% vs. 0.47), flat up to 32 strokes (1.55% versus 4.65%, χ²=1.83, p=0.18) and flat in 33-36 strokes (4.65% versus 6.98%, χ²=0.53, p=0.47), term slopes (93.80% versus 88.37%, χ²=1.98, p=0.16), operative delivery by cesarean section (13.95% vs. 2.33% versus 6.98%, χ²=2.78, p=0.10), neonatal illness (4.65% versus 10.47%, χ²=2.69, p=0.10), people babies with less than 1,500 g (1.55% vs. 5.81%, χ²=2.98, р=0.08), middle-weight babies (3,420.24±48.98 vs. 3,360.23± 66.38 g, p=0.47). With equal compliance of cuval-prophylactic visits, it was established that the breeds were evaluated in the obstetric pessary + sublingual progesterone group at 9.19 ± 0.11 points, in the obstetric pessary + vaginal progesterone group – at 7.83 ± 0.01 points.

Conclusion. Combined methods of CI correction using Dr. Arabin’s vaginal perforated obstetric pessary in combination with tablet micronized progesterone are effective and safe when using both vaginal and sublingual forms of progesterone, but the method of using a pessary and sublingual progesterone is more optimal, convenient and compliant. Both techniques can be widely used in clinical practice.