Cervical Insufficiency: Therapy

General measures

  • Bed rest and physical rest: there are no studies on prophylaxis or therapy regarding physical rest and bed rest from the point of view of cervical insufficiency. Exceptions are the opened cervix or prolapse (prolapse) of the amniotic sac. Both situations lead to hospital admission, extensive bed rest and, if possible, early surgical intervention. After prophylactic, therapeutic surgery or surgery of a prolapsed (prolapsed) amniotic sac (so-called “emergency surgery”), an accompanying pronounced physical rest or bed rest does not seem to bring any additional benefit.
  • Nicotine restriction (refrain from tobacco use).
  • Alcohol restriction (abstaining from alcohol)
  • Limited caffeine consumption (max. 240 mg of caffeine per day; equivalent to 2 to 3 cups of coffee or 4 to 6 cups of green / black tea).
  • Avoidance of psychosocial stress:
    • Stress

Conventional non-surgical therapy methods

  • In singleton pregnancies and a high-risk constellation (status post late abortion or preterm delivery) and a sonographic cervical length <25 mm before the 24th week of gestation, the following nonsurgical therapeutic procedures are equivalent to cerclage:
    • Progesterone application (intravaginal(inserted into the vagina) (see also under Prevention).
    • Cerclage pessary.
  • Additive therapies after cerclage do not appear to have any additional effect (e.g., antibiotics, bed rest, progesterone, tocolytics/inhibitory drugs).
  • Cervical pessary (cervical pessary): asymptomatic women with single pregnancies, no history of preterm birth, and a cervical length of ≤ 25 mm had a significant reduction in the incidence of preterm birth:
    • Control group preterm birth 23 of 150 women (15.3%); pessary group 11 of 150 women (7.3%); difference 8.0%, which was significant with a 95 percent confidence interval of 0.4-15.7 percentage points.

Regular checkups

  • Regular, depending on the risk situation appropriate, short-term, medical check-ups are essential.

Nutritional medicine

  • Nutritional recommendations according to a mixed diet taking into account pregnancy. This means, among other things:
    • Daily total of 5 servings of fresh vegetables and fruits (≥ 400 g; 3 servings of vegetables and 2 servings of fruits).
    • Once or twice a week fresh sea fish, i.e. fatty marine fish (omega-3 fatty acids) such as salmon, herring, mackerel.
    • High-fiber diet (whole grains, vegetables).
  • Observance of the following special dietary recommendations:
    • Restricting the consumption of coffee – women who consumed 200 mg (the equivalent of one cup of coffee) or more of caffeine per day had twice the risk of miscarriage as women who did not consume caffeine
  • Selection of appropriate foods based on the nutritional analysis.
  • See also under “Therapy with micronutrients (vital substances)” – if necessary, taking a suitable dietary supplement.
  • Detailed information on nutritional medicine you will receive from us.

Sports Medicine

There are no prophylactic or therapeutic studies or recommendations on sports activity from the point of view of cervical insufficiency. The general recommendations during pregnancy apply:

  • Do not exercise too much at the beginning of pregnancy – pregnant women who exercise more than seven hours per week have a three and a half times higher risk of miscarriage than women who avoid physical exertion; the following sports are the most dangerous: jogging, ball sports or tennis; swimming is harmless; after the 18th week of pregnancy, no increased risk of miscarriage was detectable
  • If necessary, later creation of a fitness plan with appropriate sports disciplines based on a medical check (health check).
  • Detailed information on sports medicine you will receive from us.

Psychotherapy