Annals of the Russian academy of medical sciencesAnnals of the Russian academy of medical sciencesВестник Российской академии медицинских наук0869-60472414-3545"Paediatrician" Publishers LLC127510.15690/vramn1275OBSTETRICS AND GYNAECOLOGY: CURRENT ISSUESАКТУАЛЬНЫЕ ВОПРОСЫ АКУШЕРСТВА И ГИНЕКОЛОГИИResearch ArticlePrediction of preterm birth: the role cervical assessment by ultrasound and cervico-vaginal biomarkersПрогнозирование преждевременных родов: оценка ультразвукового исследования шейки матки и цервикально-влагалищных биомаркеровhttps://orcid.org/0000-0002-5525-43537102724281RizzoGiuseppeРиццоДжузеппе
Italy

MD, PhD, Professor

д.м.н., профессор

giuseppe.rizzo@uniroma2.itMappaIleniaМаппаИления
Italy

Assistant

ассистент кафедры

mappa.ile@gmail.comhttps://orcid.org/0000-0001-8404-104265060034785930-0859BitsadzeVictoria O.БицадзеВиктория Омаровна
Russian Federation

MD, PhD, Professor

д.м.н., профессор

vikabits@mail.ruhttps://orcid.org/0000-0002-0725-968657194547147F-8384-20178225-4976KhizroevaJamilya Kh.ХизроеваДжамиля Хизриевна
Russian Federation

MD, PhD, Professor

д.м.н., профессор

jamatotu@gmail.comhttps://orcid.org/0000-0001-7415-463366023632167538-2966MakatsariyaAlexander D.МакацарияАлександр Давидович
Russian Federation

MD, PhD, Professor

д.м.н., академик РАН

gemostasis@mail.ruhttps://internist.ru/lectors/detail/makatsariya-/University of Roma Tor VergataРимский Университет Тор ВергатаThe First I.M. Sechenov Moscow State Medical University (Sechenov University)Первый Московский государственный медицинский университет имени И.М. Сеченова (Сеченовский Университет)Unive rsity of Roma Tor VergataРимский Университет Тор Вергата20092020141020207542692772901202023082020Copyright ©; 2020, "Paediatrician" Publishers LLCCopyright ©; 2020, Издательство "Педиатръ"2020"Paediatrician" Publishers LLCИздательство "Педиатръ"https://vestnikramn.spr-journal.ru/jour/article/view/1275

Preterm delivery (PTB) is one of the most common and serious complications of pregnancy. PTB accounts for approximately 70% of neonatal deaths and is a major cause of neonatal morbidity including respiratory distress syndrome, necrotising enterocolitis and long-term neurological disabilities. Prevention of PTB and its complications include identification among symptomatic women those at high risk of immediate delivery requiring prenatal corticosteroids administration. Transvaginal ultrasonographic evaluation of the cervical length (CL) is predictive of PTB and a value < 15 mm identifies among symptomatic women approximately 70% of women who will deliver within one week. In the range of CL within 15 and 30 mm biomarkers in cervical-vaginal fluids (fetal fibronectin, phosphorylated insulin-like growth factor protein-1, placental alpha-microglobulin-1, cytokines) and other ultrasonographic cervical variables (posterior cervical angle, elastography) improve the identification of women at risk. In asymptomatic women CL can be applied as screening and has been proposed as a universal screening during the second trimester in singleton gestations. The finding of a CL ≤ 25 mm is associated with an increased risk of subsequent PTB with a sensitivity between 30 and 60% that is improved with the combination of biomarkers. Asymptomatic women with a CL ≤ 25 mm should be offered vaginal progesterone treatment for the prevention of preterm birth and neonatal morbidity. The role of cerclage and pessary is still controversial. In this review we discuss the evidence-based role of ultrasonographic cervical assessment and cervicovaginal biomarkers in the prediction of PTB in symptomatic and asymptomatic women.

Преждевременные роды (ПР) — одно из наиболее распространенных и серьезных осложнений беременности. Преждевременные роды приблизительно в 70% приводят к ранней неонатальной смертности и являются основной причиной возникновения заболеваний у новорожденных, включая респираторный дистресс-синдром, некротизирующий энтероколит и длительные неврологические нарушения. Профилактика ПР и их осложнений включает прежде всего выявление женщин с высоким риском развития ПР, требующих пренатального введения кортикостероидов. Трансвагинальная ультразвуковая оценка длины шейки матки (цервикометрия) является прогностическим показателем развития ПР: так, длина шейки матки < 15 мм свидетельствует о том, что около 70% женщин родят в течение 1 нед. Если значение при цервикометрии в пределах 15–30 мм, то определяют биомаркеры ПР в шеечно-влагалищном содержимом (фетальный фибронектин, фосфорилированный протеин-1, связывающий инсулиноподобный фактор роста, плацентарный альфа-микроглобулин, цитокины) и другие эхографические цервикальные измерения (такие как задний шейный угол, эластография) для улучшения прогнозирования развития ПР у женщин из группы риска. У женщин без клинической картины цервикометрия может быть применена в качестве скрининга. Также она была предложена при одноплодной беременности в качестве универсального скрининга во втором триместре. Нахождение указанного показателя в пределах ≤ 25 мм связано с повышенным риском развития ПР (чувствительность от 30 до 60%), данные являются более точными при комбинации с биомаркерами. Бессимптомным женщинам с длиной шейки матки ≤ 25 мм должно быть предложено лечение микронизированным прогестероном для профилактики ПР и неонатальной заболеваемости. Роль цервикального серкляжа и пессария остается спорной. В данном обзоре обсуждается доказательная роль ультразвукового исследования шейки матки и цервикально-вагинальных биомаркеров в прогнозировании развития ПР у симптоматических и бессимптомных женщин.

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