Empleo del pesario cervical en la prevención del parto prematuro
Palabras clave:
Pesario cervical, Parto pretérmino, Insuficiencia cervical, Progesterona, Manejo expectanteResumen
El parto pretérmino representaba una de las principales causas de morbimortalidad perinatal, con significativas repercusiones sociales y económicas a nivel mundial. La identificación temprana de factores de riesgo y una intervención adecuada lograban reducir su incidencia y minimizar las consecuencias de la prematurez. Este estudio se llevó a cabo con el propósito de resaltar el pesario cervical como una herramienta mecánica en la prevención del parto pretérmino y como una opción terapéutica para embarazos de más de 25 semanas con insuficiencia cervical. Se presentó el caso de una paciente de 38 años con antecedente de parto pretérmino espontáneo a las 33 semanas, quien ingresó al hospital con 21 semanas de gestación, presentando una dilatación cervical de 3 cm y un acortamiento de la longitud cervical de 14mm. Además, los signos ecográficos mostraban la presencia de sludge y funneling. Se optó por un manejo expectante complementado con la administración de antibióticos, progesterona y el uso de un pesario cervical. Tras el control de la infección y la progresión del acortamiento cervical a 7 mm, a pesar del tratamiento con progesterona, se decidió colocar un pesario cervical a las 25,5 semanas. Posteriormente, a las 27,5 semanas, la paciente fue dada de alta y, finalmente, a las 36,6 semanas, el pesario fue retirado debido al inicio de la actividad uterina. La progesterona y el cerclaje habían sido las opciones de elección en casos de insuficiencia cervical; sin embargo, ante las dificultades técnicas para la colocación del cerclaje, el pesario representó una alternativa viable. El uso del pesario permitió que el embarazo alcanzara el término con resultados favorables y sin evidencia de efectos adversos.
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