Features of isthmic-cervical insufficiency formation in undifferentiated connective tissue dysplasia and anovulatory disorders: a comparative analysis | Ukrainian Medical Journal

Henyk N.I.,Perkhulyn O.M.,Prudnikov P.M.,Orishchak I.K.

Main
Publications
Features of isthmic-cervical insufficiency formation in undifferentiated connective tissue dysplasia and anovulatory disorders: a comparative analysis

Features of isthmic-cervical insufficiency formation in undifferentiated connective tissue dysplasia and anovulatory disorders: a comparative analysis

May 29, 2026

Obstetrics and Gynecology

УДК: 618.3-06:618.146-007.1:616-007.17:618.177

DOI: 10.32471/umj.1680-3051.277104

Keywords :

anovulatory disorders,

cervicometry,

isthmic-cervical insufficiency,

polycystic ovary syndrome,

preterm birth,

undifferentiated connective tissue dysplasia

Specialities :

Obstetrics and Gynecology

Resume

The aim of the study was to compare clinical, anamnestic, phenotypic, reproductive and gestational features of isthmic-cervical insufficiency formation in pregnant women with anovulatory disorders and undifferentiated connective tissue dysplasia. Object and methods of the research. An comparative clinical and anamnestic study included 178 pregnant women with verified cervical insufficiency: 92 women with cervical insufficiency associated with anovulatory disorders and 86 women with cervical insufficiency associated with clinical markers of undifferentiated connective tissue dysplasia. Results. In the anovulatory disorders group, opsomenorrhea (53.26%), polycystic ovary syndrome (31.52%), hyperandrogenism (21.74%), in vitro fertilization (53.26%) and controlled ovarian stimulation (72.83%) were more frequent. In the connective tissue dysplasia group, generalized joint hypermobility (60.47%), skin hyperextensibility (40.70%), easy bruising (36.05%), mitral valve prolapse (25.58%) and varicose disease (27.91%) predominated. Anovulatory disorders were associated with a higher frequency of threatened early miscarriage (51.09% vs. 30.23%; p=0.005), placental dysfunction (58.70% vs. 36.05%; p=0.003) and polyhydramnios (25.00% vs. 11.63%; p=0.022). In the connective tissue dysplasia group, premature rupture of membranes (23.26% vs. 9.78%; p=0.015) and obstetric soft tissue trauma (26.74% vs. 8.70%; p=0.002) were more common. The frequency of preterm birth was comparable in both groups: 26.08% and 24.42%. Conclusion. The results indicate two clinical models of cervical insufficiency: a hormonal-regulatory model in anovulatory disorders and a structural-matrix model in undifferentiated connective tissue dysplasia.

References

1. Society for Maternal-Fetal Medicine (SMFM), Biggio J., SMFM Publications Committee (2024) SMFM Consult Series #70: Management of short cervix in individuals without a history of spontaneous preterm birth. Am. J. Obstetr. Gynecol., 231(2): B2–B13. doi.org/10.1016/j.ajog.2024.05.006.
2. Thakur M., Jenkins S.M., Mahajan K. (2024) Cervical insufficiency. In StatPearls. StatPearls Publ. pubmed.ncbi.nlm.nih.gov/30247829.
3. Levitsky I.V., Kinash N.M. (2022) Modern aspects of the etiopathogenesis of istmic-cervical insufficiency. Art of Medicine, 22(2): 136–141. doi.org/10.21802/artm.2022.2.22.136.
4. Ibadova T.V., Maliar V.V., Maliar V.A., Maliar V.V. (2022) Comprehensive evaluation of the premature birth in women with undifferentiated connective tissue dysplasia. UMJ, 5(151). doi.org/10.32471/umj.1680-3051.151.234210.
5. Rymarchuk M.I., Henyk N.I., Perkhulyn O.M. (2024) Vahitnist ta nedyferentsiiovana dysplaziia spoluchnoi tkanyny. Aktualni pytannia pediatrii, akusherstva ta hinekolohii, 2: 15084. doi.org/10.11603/24116-4944.2024.2.15084.
6. Pezaro S., Pearce G., Reinhold E. et al. (2024) Management of childbearing with hypermobile Ehlers-Danlos syndrome and hypermobility spectrum disorders. PLOS ONE, 19(5): e0302401. doi.org/10.1371/journal.pone.0302401.
7. Mitsoda R.M., Maliar V.V. (2026) Markers of collagen metabolism during pregnancy with undifferentiated connective tissue dysplasia. UMJ, doi.org/10.32471/umj.1680-3051.276058.
8. Sekar S., Fernando S., Budithi S. (2024) Association between polycystic ovarian syndrome and incompetent uterine cervix: A systematic review and meta-analysis. J. Gynecol. Obstetr. Human Reproduct., 53(5): 102763. doi.org/10.1016/j.jogoh.2024.102763.
9. Khomami M.B., Hashemi S., Shorakae S. et al. (2024) Systematic review and meta-analysis of birth outcomes in women with polycystic ovary syndrome. Nature Communications, 15(1): 5592. doi.org/10.1038/s41467-024-49752-6.
10. World Medical Association (2013) World Medical Association Declaration of Helsinki: Ethical principles for medical research involving human subjects. JAMA, 310(20): 2191–2194. doi.org/10.1001/jama.2013.281053.
11. Sugita Y., Kuwabara Y., Katayama A. et al. (2023) Characteristic impairment of progesterone response in cultured cervical fibroblasts obtained from patients with refractory cervical insufficiency. Sci. Rep., 13(1): 11709. doi.org/10.1038/s41598-023-37732-7.
12. Tripathy S., Nallasamy S., Mahendroo M. (2022) Progesterone and its receptor signaling in cervical remodeling: Mechanisms of physiological actions and therapeutic implications. J. Steroid Biochem. Mol. Biol., 223: 106137. doi.org/10.1016/j.jsbmb.2022.106137.
13. Løvvik T.S., Stridsklev S., Carlsen S.M. et al. (2016) Cervical length and androgens in pregnant women with polycystic ovary syndrome: Has metformin any effect? J. Clin. Endocrinol. Metabol., 101(6): 2325–2331. doi.org/10.1210/jc.2015-3498.
14. Cheng T., Shi H., Bu Z. et al. (2024) Contribution of cervical incompetence to occurrence of second trimester abortion in patients with polycystic ovary syndrome during the frozen embryo transfer cycle. Front. Endocrinol., 15: 1411618. doi.org/10.3389/fendo.2024.1411618.
15. Wang Y., Gu X., Tao L., Zhao Y. (2016) Co-morbidity of cervical incompetence with polycystic ovarian syndrome (PCOS) negatively impacts prognosis: A retrospective analysis of 178 patients. BMC Pregnancy and Childbirth, 16(1): 308. doi.org/10.1186/s12884-016-1094-6.
16. Teede H.J., Tay C.T., Laven J.J.E. et al. (2023) Recommendations from the 2023 international evidence-based guideline for the assessment and management of polycystic ovary syndrome. J. Clin. Endocrinol. Metabol., 108(10): 2447–2469. doi.org/10.1210/clinem/dgad463.
17. Aihaiti R., Shen Z., Wu X., Niu Z. (2024) Pregnancy complications and birth outcomes in women with polycystic ovary syndrome undergoing frozen embryo transfer. Fertility and Sterility, 122(6): 1055–1062. doi.org/10.1016/j.fertnstert.2024.07.017.
18. Yellon S.M. (2017) Contributions to the dynamics of cervix remodeling prior to term and preterm birth. Biology of Reproduction, 96(1): 13–23. doi.org/10.1095/biolreprod.116.142844.
19. Amabebe E., Ogidi H., Anumba D.O. (2022) Matrix metalloproteinase-induced cervical extracellular matrix remodelling in pregnancy and cervical cancer. Reproduction and Fertility, 3(3): R177–R191. doi.org/10.1530/RAF-22-0015.
20. Wu W., Sun Z., Gao H. et al. (2024) Whole cervix imaging of collagen, muscle, and cellularity in term and preterm pregnancy. Nature Communications, 15: 5942. doi.org/10.1038/s41467-024-48680-9.