Desafios na prevenção do parto pré-termo associado à insuficiência cervical
DOI:
https://doi.org/10.5327/JBG-2965-3711-2024134103%20Palavras-chave:
cerclagem cervical, incompetência do colo do útero, pessário, progesteronaResumo
Introdução: A insuficiência cervical é um importante fator de risco de prematuridade, principal causa de morbidade e mortalidade perinatais. Objetivo: Revisar critérios diagnósticos e estratégias para reduzir partos pré-termos associados à insuficiência cervical. Métodos: Revisão bibliográfica dos últimos cinco anos (2018–2023), nas bases de dados Pubmed e Biblioteca Virtual em Saúde, usando descritores relacionados à insuficiência cervical. Foram consideradas revisões sistemáticas e metanálises, e guidelines. Resultados: Foram incluídos 69 artigos. A insuficiência cervical tem critérios diagnósticos pouco claros. As evidências atuais orientam que seu diagnóstico pode ser obtido através da história obstétrica sugestiva, da identificação de colo curto (≤25 mm) por meio de ultrassom, ou colo dilatado na ausência de trabalho de parto na gestação atual. Em mulheres com história sugestiva de insuficiência cervical, é indicada cerclagem eletiva. Em gestações únicas submetidas à vigilância por ultrassom do comprimento cervical entre 160/7 e 246/7 semanas, deve ser oferecida cerclagem para colo curto. Em gestação única, a progesterona está indicada na história de parto pré-termo espontâneo, ou quando observado colo curto no ultrassom transvaginal mesmo sem história de parto pré-termo anterior. Em pacientes de risco habitual, a medida de colo uterino é indicada entre 18 e 24 semanas de gestação, durante o ultrassom morfológico de segundo trimestre. Não há evidências suficientes que suportem o uso do pessário para prevenção de parto pré-termo. Em gestações gemelares não selecionadas, não há evidências para uso de progesterona ou cerclagem cervical para redução de parto pré-termo. Conclusão: A decisão sobre a melhor forma de minimizar o risco de perda gestacional associada à insuficiência cervical deve ser individualizada, considerando a história obstétrica, o encurtamento (ou dilatação) cervical, a experiência da equipe assistencial e o consentimento da gestante.
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Referências
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