Short cervix: modern perspectives on known problems

The article provides modern literature data on terminology, diagnostics and new approaches to the treatment of short cervix syndrome. The term «short cervix» combines the concept of short cervix and isthmic-cervical insufficiency in most of the guiding documents of the world obstetrics and gynecology societies. However, the issues of diagnosis and correction of these conditions remain relevant and debatable: sonographic criteria, the use of progesterone, cerclage, obstetric pessaries, their various combinations, and the question of their effectiveness. It is necessary to measure the cervix length by transvaginal cervicometry in the 20 weeks of pregnancy in the absence of previous reproductive losses and in the period of 14–16 weeks if there were previous reproductive losses. Therapeutic interventions should be started (vaginal micronized progesterone, cerclage, obstetric pessary) when the cervix is shortened to 25 mm or less at 20 weeks. Urgent cerclage should be performed when the umbilical cord is shortened to 20 mm or less. The effectiveness of cerclage, according to most experts, is comparable to the effectiveness of vaginal progesterone, unlike obstetric pessaries, the effectiveness of which is currently considered unproven. For our country today, in addition to the generally recognized risk factors of this pathology, the factors associated with improper conditions for providing medical care and their consequences are especially relevant. Childbirth in inappropriate places without observing the rules of asepsis and antiseptics, often without qualified medical personnel, can lead to undiagnosed and lack of suturing of cervical tears), their infection, subsequent deformation and functional failure of the cervix. There is also a need to support the micronutrient status of pregnant women in wartime conditions in Ukraine (vitamins of group B, vitamin D, magnesium, polyunsaturated fatty acids) in combination with progestins (micronized progesterone Luteinа) and/or cerclage in case of short cervix.