Treatment of Cervical Insufficiency Abortion by Zamzam Water Activated Autologeous Human Peripheral Blood Mononuclear Cell, Modern Trend

Treatment of cervical insufficiency abortion is by cerclage which either done vaginally (Shirodkar, McDonald) or abdominally and laparoscopically. Due to many complications arise from cerclage a need for non-invasive or minimally invasive procedure is urgent. As mononuclear cell is a potential regulator of cell proliferation, stimulate progesterone by luteal cells, promote embryo invasion, stimulate adenosine tri phosphate, improving mitochondrial respiration, strong anti-microbial, hence comes its application in cervical wall injection. Aim of the work: to use for the first time in the literature zamzam water activated autologous mononuclear cell intracervically to treat repeated abortion due to cervical insufficiency. Subject and methods: 50 pregnant women at a period of gestation between 8-10 weeks to exclude fetal causes of abortion. Informed consent was taken. The mean age of women was 30±3.5, a mean number of abortion was 8.2±2.6 were enrolled in the study, inclusion criteria were historical and radiological features of cervical insufficiency. Transvaginal ultrasound for measurement of absolute cervical length, cervical effacement. Exclusion criteria: previous cerclage, other causes of abortion, medical and genetic disorder, previous progestational drugs, viral hepatitis and blood diseases. Ultrasound was done before the procedure for diagnosis and then every 2 weeks after the procedure, also cervical smear for aquaporin and cervical mucous for detection of IL8, collagenease, were done before the procedure and at the time of delivery. Fetal evaluation by Apgar score and fetal weight was done. PBMCs were obtained from the patients and were cultured with 10 c.c sterile zamzam water for 3 days, and then administered in the cervical wall. Results: full term delivery occurred in 48 cases (96%), abortion 2 cases (4%), cesarean section 45 cases (90%), vaginal delivery 5 cases (10%). No fetal or maternal complication was reported. Thirteenth International Water Technology Conference, IWTC 13 2009, Hurghada, Egypt Conclusion: Treatment of cervical insufficiency by cervical injection of zamzam activated autologus human peripheral blood mononuclear cell (PBMCS) is safe, effective, and cheap with positive fetal effect and no fetomaternal complications, but more cases and randomization is needed before elucidation the effectiveness of the procedure.