Дискуссионные вопросы применения акушерского пессария при истмико-цервикальной недостаточности

Преждевременные роды (ПР) остаются одной из наиболее значимых проблем акушерства во всем мире, которая не теряет своей актуальности. Ежегодно около 15 млн детей рождается преждевременно. Преждевременные роды являются основной причиной неонатальной и младенческой смертности, а также детской заболеваемости, отдаленных неврологических последствий и инвалидности, особенно при экстремально ранних ПР (22−28 недель). Показатель летальности при рождении в сроке 22−24 недели достигает 98%. Показано, что риск повторных преждевременных родов достаточно высок. Если прошлая беременность прервалась в сроке 23−28 недель гестации, то в ¼ случаев ПР повторятся вновь в сроке до 28 недель. Этиология ПР многофакторна, и одним из наиболее значимых факторов риска является истмико-цервикальная недостаточность (ИЦН). Применение того или иного метода коррекции короткой шейки матки зависит от анамнеза, клинической ситуации, противопоказаний, данных цервикометрии, опыта врача и т.д. Одним из наиболее приемлемых способов коррекции ИЦН является установка цервикального пессария. В основе механизма действия акушерского пессария лежит снижение гидравлического давления плодного пузыря на внутренний зев, что способствует снижению риска дальнейшего укорочения шейки матки. Данный способ не требует хирургического вмешательства, демонстрирует низкий риск осложнений и прост в применении. Опубликовано большое количество научных работ, которые демонстрируют эффективность применения пессария у пациенток с короткой шейкой матки. Однако данные литературы противоречивы и требуют проведения дальнейших исследований.

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