Berghella Vincenzo, Haas Susan, Chervoneva Inna, Hyslop Terry
Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Jefferson Medical College of Thomas Jefferson University, Philadelphia, Pa., USA.
Am J Obstet Gynecol. 2002 Sep;187(3):747-51. doi: 10.1067/mob.2002.124289.
To compare management with prophylactic cerclage versus serial transvaginal sonograms of the cervix in patients with prior second-trimester loss.
Singleton pregnancies with prior second-trimester spontaneous loss between 14 and 24 weeks' gestation were retrospectively reviewed. At the obstetricians' discretion, some were managed with prophylactic cerclage and some with serial transvaginal sonograms of the cervix, starting at 14 weeks, and cerclage only if cervical length was <25 mm or funneling was >25% before 24 weeks. All cerclages were McDonald. Primary outcome was preterm delivery at <35 weeks.
Of 177 patients with singleton pregnancies who had prior second-trimester loss identified, 66 received prophylactic cerclage and 111 were followed up with transvaginal sonography, of which 36% (40/111) had therapeutic cerclage because of cervical changes. The two management groups of prophylactic cerclage versus transvaginal sonography of the cervix did not differ in any measure of obstetric outcome, including preterm delivery at <35 weeks (23% vs 30%; P =.3), preterm delivery at <33 weeks (21% vs 26%; P =.5), or gestational age at delivery (34.6 +/- 6.8 weeks vs 34.4 +/- 6.8 weeks; P =.8).
In patients with prior second-trimester loss, serial transvaginal sonography of the cervix, with cerclage only if indicated by cervical changes, is a valuable alternative to a policy of uniform prophylactic cerclage.
比较对既往有孕中期流产史患者采用预防性宫颈环扎术与系列经阴道宫颈超声检查的管理效果。
回顾性分析单胎妊娠且既往有孕中期14至24周自然流产史的患者。根据产科医生的判断，部分患者采用预防性宫颈环扎术进行管理，部分患者从14周开始采用系列经阴道宫颈超声检查，仅在孕24周前宫颈长度<25 mm或漏斗形成>25%时进行宫颈环扎术。所有宫颈环扎术均采用麦克唐纳法。主要结局是孕35周前早产。
在177例确诊有既往孕中期流产史的单胎妊娠患者中，66例接受了预防性宫颈环扎术，111例接受经阴道超声检查随访，其中36%（40/111）因宫颈变化接受了治疗性宫颈环扎术。预防性宫颈环扎术与经阴道宫颈超声检查这两种管理组在任何产科结局指标上均无差异，包括孕35周前早产（23%对30%；P = 0.3）、孕33周前早产（21%对26%；P = 0.5）或分娩时孕周（34.6±6.8周对34.4±6.8周；P = 0.8）。
对于既往有孕中期流产史的患者，系列经阴道宫颈超声检查，仅在宫颈变化提示时进行宫颈环扎术，是统一预防性宫颈环扎术策略的一种有价值的替代方法。
