Cockwell Heather A, Smith Graeme N
Department of Obstetrics and Gynecology, Kingston General Hospital, Queen's University, Kingston, Ontario, Canada.
J Obstet Gynaecol Can. 2005 Feb;27(2):123-9. doi: 10.1016/s1701-2163(16)30184-0.
To evaluate the role of emergency cerclage for women who present with a dilated external cervical os and bulging or "hour-glassing" membranes. We examined overall experiences at Kingston General Hospital (KGH) from 2000 to 2004 and conducted a literature review for the period January 1, 1995, to December 31, 2004.
A search for cerclages placed by operators in Kingston revealed 12 pregnancies in the period between 2000 and 2004. We reviewed the charts for these women and for their infants. We conducted a literature review, using the terms "cerclage," "cervical," "emergent or emergency cerclage," "rescue cerclage," and "incompetent cervix," using an OVID interface to access MEDLINE records. We excluded articles in which the diagnosis of cervical incompetence was made using ultrasound, because its predictive value has not been shown in randomized trials. The most recent review of this type was carried out in 1995; since then, an additional 24 articles have been published that met our inclusion and exclusion criteria.
The average time between cerclage placement and delivery at KGH was 7 weeks, which allowed for 10 of 13 infants (one twin pregnancy) to be born at 28 weeks or later. Three infants were born weighing under 1 kg; the 10 remaining infants weighed over 1 kg. Histological data are available for 12 placentas of the 13 infants delivered; 7 infants had a histological diagnosis of chorioamnionitis; none of the blood cultures from any of the infants post-delivery revealed septicemia. The literature review identified 638 women. Where reported, the average prolongation of the pregnancy was 7 weeks plus 1 day. This allowed for 60% of infants (range 26% to 80%) to be born after 28 weeks, with an average neonatal survival of over 70% (range 47.2% to 96%). Preterm premature rupture of membranes complicated an average of 29% of pregnancies (range 1% to 58%), and chorioamnionitis was reported in 5% to 80% of pregnancies.
The KGH data collected and the data available in the literature suggest that emergency cerclage, under ideal circumstances, can significantly prolong pregnancy and increase the chance of viable pregnancy outcome. However, in counselling women about the potential therapeutic benefit of emergency cerclage, the increased risk of chorioamnionitis and its associated risk of fetal inflammatory brain injury, as well as the risk of extending a pregnancy from pre-viability to severe prematurity, should be discussed. A longer-term follow-up than has been carried out here is required for better elucidation of the effect of chorioamnionitis on those infants in childhood and beyond.
评估紧急宫颈环扎术对宫颈外口扩张且胎膜膨出或呈“沙漏状”的女性的作用。我们研究了2000年至2004年期间金斯顿综合医院（KGH）的总体情况，并对1995年1月1日至2004年12月31日期间的文献进行了综述。
在金斯顿，通过查找手术医生实施的宫颈环扎术发现，2000年至2004年期间有12例妊娠。我们查阅了这些女性及其婴儿的病历。我们使用“宫颈环扎术”“宫颈”“紧急宫颈环扎术”“补救性宫颈环扎术”和“宫颈机能不全”等术语，通过OVID界面检索MEDLINE记录进行文献综述。我们排除了使用超声诊断宫颈机能不全的文章，因为其预测价值在随机试验中尚未得到证实。此类的最新综述于1995年进行；此后，又有24篇符合我们纳入和排除标准的文章发表。
在KGH，宫颈环扎术至分娩的平均时间为7周，这使得13例婴儿中的10例（1例双胎妊娠）在28周或更晚出生。3例婴儿出生时体重不足1千克；其余10例婴儿体重超过1千克。13例分娩婴儿中的12例胎盘有组织学数据；7例婴儿有绒毛膜羊膜炎的组织学诊断；分娩后任何婴儿的血培养均未显示败血症。文献综述确定了638名女性。据报道，妊娠平均延长7周零1天。这使得60%的婴儿（范围为26%至80%）在28周后出生，新生儿平均存活率超过70%（范围为47.2%至96%）。胎膜早破平均使29%的妊娠复杂化（范围为1%至58%），5%至80%的妊娠报告有绒毛膜羊膜炎。
KGH收集的数据和文献中的数据表明，在理想情况下，紧急宫颈环扎术可显著延长妊娠并增加存活妊娠结局的机会。然而，在向女性咨询紧急宫颈环扎术的潜在治疗益处时，应讨论绒毛膜羊膜炎风险增加及其相关的胎儿炎性脑损伤风险，以及将妊娠从未存活期延长至重度早产的风险。为了更好地阐明绒毛膜羊膜炎对这些婴儿儿童期及以后的影响，需要进行比本研究更长时间的随访。
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