Association of Progesterone, Pessary, and Antibiotic for Treating Pregnant Woman with Short Cervix Syndrome: Importance of Magnetic Resonance Imaging in the Assessment of Pessary Position
Open Access
- 30 June 2013
- journal article
- case report
- Published by Scientific Scholar in Journal of Clinical Imaging Science
- Vol. 3 (1), 27
- https://doi.org/10.4103/2156-7514.114802
Abstract
Preterm delivery (PD) is the most important cause of neonatal mortality, particularly before the 32nd week of pregnancy. A short cervix is the most important quantitative marker for predicting PD. However, there are other qualitative markers such as cervical gland area, cervical funneling, and sludge. We present the case of a pregnant woman who was diagnosed with a short cervix at 14-weeks and demonstrate the use of triple therapy, which helped to achieve a good perinatal result. A 37-year-old pregnant woman (G3P0) was referred to our service at 14-weeks of pregnancy presenting with a short cervix (20 mm) and a positive sludge sign. She was hospitalized; a pessary was inserted, and started on antibiotic therapy (clindamycin and cefalotin for 10 days). At 20 weeks, she was again admitted to the hospital, and this time presented with a further shortened cervix (9 mm), cervical funneling, and a positive sludge sign, with the pessary in position. The following procedures were performed: Amniocentesis on the sludge (negative bacterioscopy), another cycle of antibiotics, administration of oral progesterone, and imaging to determine retention of pessary position. The patient was placed in the Trendelenburg position and remained hospitalized for 82 days. At 32 + 1 weeks, the fetus presented distress (tachycardia). C-section was performed, producing a live female newborn weighing 2,180 g and presenting Apgar indexes of 8/8. This case report demonstrates the importance of magnetic resonance imaging to assess the position of pessary in a pregnant woman with short cervix.Keywords
This publication has 10 references indexed in Scilit:
- Cervical pessary in pregnant women with a short cervix (PECEP): an open-label randomised controlled trialThe Lancet, 2012
- Prématurité et infection : état des connaissancesJournal de Gynécologie Obstétrique et Biologie de la Reproduction, 2012
- A Short Cervical Length in Pregnancy: Management OptionsAmerican Journal of Perinatology, 2009
- Some thoughts on the true value of ultrasoundUltrasound in Obstetrics & Gynecology, 2007
- Progesterone and the Risk of Preterm Birth among Women with a Short CervixNew England Journal of Medicine, 2007
- Cervical gland area as an ultrasonographic marker for preterm deliveryInternational Journal of Gynecology & Obstetrics, 2006
- The prevalence and clinical significance of amniotic fluid ‘sludge’ in patients with preterm labor and intact membranesUltrasound in Obstetrics & Gynecology, 2005
- Preterm delivery: an overviewActa Obstetricia et Gynecologica Scandinavica, 2003
- Prevention of Premature BirthNew England Journal of Medicine, 1998
- The Length of the Cervix and the Risk of Spontaneous Premature DeliveryNew England Journal of Medicine, 1996