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Treatment of isthmic cervical insufficiency outside of pregnancy
Last reviewed: 08.07.2025
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When isthmic-cervical insufficiency is detected, treatment should be etiological. Thus, in case of gross anatomical changes in the cervix caused by old ruptures (if this is the only reason for miscarriage), surgical treatment outside of pregnancy is necessary (cervical plastic surgery).
Before surgical treatment, a thorough bacteriological examination and prophylactic antibacterial treatment are necessary, since in most cases of isthmic-cervical insufficiency the uterine cavity is infected due to the absence of the locking function of the isthmic part of the cervix.
The first operation on the cervix outside pregnancy for isthmic-cervical insufficiency was proposed by Lasha et al. (1950). The operation consists of excising an oval flap of tissue to remove scar tissue at the site of the rupture in order to restore the fibromuscular integrity of the cervix.
Currently, several modifications of the Lasch method are known.
The original method of reconstructive plastic surgery on the cervix was proposed by V.I. Yeltsov-Strelkov et al. (1979). The operation consists of five stages:
- dissection of the neck,
- cervical dissection,
- formation of the cervical canal,
- formation of the external os,
- final formation of the cervix.
If pregnancy occurs after plastic surgery on the cervix, it is advisable to deliver the baby by cesarean section.
In case of functional isthmic-cervical insufficiency or anatomical, but not requiring reconstructive surgery, the first stage of preparation for the next pregnancy is a thorough bacteriological examination and antibacterial therapy taking into account the pathogen during 2-3 menstrual cycles in combination with physiotherapy. After this, immunological and hormonal control and pathogenetic therapy are necessary taking into account the data obtained. Hormonal preparation is the final stage of treatment before pregnancy. Surgical operation for isthmic-cervical insufficiency is performed during pregnancy.