Davis G, Berghella V, Talucci M, Wapner R J
Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Jefferson Medical College of Thomas Jefferson University, Philadelphia, Pennsylvania, USA.
Am J Obstet Gynecol. 2000 Oct;183(4):836-9. doi: 10.1067/mob.2000.108837.
Our purpose was to compare the incidence of preterm birth after a prior failed vaginal cerclage in patients who had a subsequent transabdominal or a transvaginal cerclage.
We conducted a retrospective cohort study of singleton pregnancies in women who had undergone (9-14 weeks) either a transabdominal or a transvaginal prophylactic cerclage after >/=1 prior failed transvaginal cerclage. Prior failed transvaginal cerclage was defined as a preterm birth at <33 weeks' gestation in the immediate prior pregnancy despite a transvaginal cerclage. All transabdominal cerclage procedures were performed by a single attending physician (George Davis, DO). Patients with a cervix too short for transvaginal cerclage placement, placenta previa, or major fetal anomalies were excluded. Primary outcome was preterm birth at <35 weeks' gestation.
Forty transabdominal and 24 transvaginal cerclage pregnancies were analyzed. These 2 groups were similar in race and payer status but differed in age (34.0 +/- 4.2 vs 31.3 +/- 4.6 years, respectively; P =.01). The transabdominal cerclage group had more prior failed cerclage procedures per patient (1.8 +/- 1.0 vs 1.1 +/- 0.3; P =.02) and more prior 14- to 24-week spontaneous abortions per patient (2.4 +/- 1.3 vs 1.5 +/- 1.0; P =.02) than the transvaginal cerclage group. Preterm delivery at both <35 and <33 weeks' gestation was less common in the transabdominal cerclage group (18% vs 42%, P =.04; 10% vs 38%, P =.01; respectively) than in the transvaginal cerclage group. Gestational age at delivery was 36. 3 +/- 4.1 weeks in the transabdominal cerclage group and 32.8 +/- 8. 6 weeks in the transvaginal cerclage group (P =.03). Preterm premature rupture of membranes also occurred less often in the transabdominal cerclage group than in the transvaginal cerclage group (8% vs 29%, P =.03).
In patients with a prior failed transvaginal cerclage, transabdominal cerclage is associated with a lower incidence of preterm delivery and preterm premature rupture of membranes in comparison with transvaginal cerclage.
我们的目的是比较先前阴道环扎失败的患者在随后接受经腹或经阴道环扎后的早产发生率。
我们对单胎妊娠妇女进行了一项回顾性队列研究，这些妇女在≥1次先前阴道环扎失败后于孕9至14周接受了经腹或经阴道预防性环扎。先前阴道环扎失败定义为尽管进行了阴道环扎，但在前次妊娠中妊娠<33周时早产。所有经腹环扎手术均由一位主治医师（George Davis，医学博士）完成。宫颈过短无法进行阴道环扎、前置胎盘或有严重胎儿畸形的患者被排除。主要结局是妊娠<35周时早产。
分析了40例经腹环扎和24例经阴道环扎的妊娠。这两组在种族和付款人状态方面相似，但年龄不同（分别为34.0±4.2岁和31.3±4.6岁；P = 0.01）。与经阴道环扎组相比，经腹环扎组每位患者先前环扎失败的次数更多（1.8±1.0次对1.1±0.3次；P = 0.02），每位患者先前14至24周自然流产的次数也更多（2.4±1.3次对1.5±1.0次；P = 0.02）。妊娠<35周和<33周时的早产在经腹环扎组比经阴道环扎组少见（分别为18%对42%，P = 0.04；10%对38%，P = 0.01）。经腹环扎组分娩时的孕周为36.3±4.1周，经阴道环扎组为32.8±8.6周（P = 0.03）。经腹环扎组胎膜早破的发生率也低于经阴道环扎组（8%对29%，P = 0.03）。
在先前阴道环扎失败的患者中，与经阴道环扎相比，经腹环扎与早产和胎膜早破的发生率较低相关。
