Verhinderung von Spätaborten und Frühgeburten

Operations at the uterine cervix to prevent miscarriages and preterm deliveries are based on two premises: (1) a cerclage can prevent premature opening of the cervix due to cervical incompetence and (2) operative occlusion of the cervical canal can prevent transcervical infections following incomplete narrowing of the internal os, insufficient mucous sealing of the cervix, or as a consequence of cervical lacerations. Cervical incompetence in the classic sense is an extremely rare finding. In women deemed to be at increased risk of cervical incompetence, cerclage was not found to prolong pregnancy significantly. It is still unclear whether cervical cerclage can improve outcomes of pregnancies in women with decreased cervical length or dilation of the internal os as detected by vaginal ultrasound. Indications and outcomes of the rare cervix occlusion operations have not as yet been studied in prospective randomized trials. In spite of this, some results suggest that women with a history of repeated miscarriages caused by ascending infections due to sealing deficits of the cervix may profit from an operation.