Berghella Vincenzo, Odibo Anthony O, To Meekai S, Rust Orion A, Althuisius Sietske M
Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Jefferson Medical College of Thomas Jefferson University, Philadelphia, PA 19107, USA.
Obstet Gynecol. 2005 Jul;106(1):181-9. doi: 10.1097/01.AOG.0000168435.17200.53.
Preterm birth is the main cause of perinatal morbidity and mortality. A short cervical length on transvaginal ultrasonography predicts preterm birth. Our aim was to estimate by meta-analysis of randomized trials whether cerclage prevents preterm birth in women with a short cervical length.
MEDLINE, PubMed, EMBASE, and the Cochrane Library were searched with the terms "cerclage," "cervical cerclage," "short cervix," "ultrasound," and "randomized trial." We included randomized trials involving the use of cerclage in women with short cervical length on transvaginal ultrasonography using patient-level data.
TABULATION, INTEGRATION, AND RESULTS: Four properly conducted trials were identified. In the total population, preterm birth at less than 35 weeks of gestation occurred in 29.2% (89/305) of the cerclage group, compared with 34.8% (105/302) of the no-cerclage groups (relative risk [RR] 0.84, 95% confidence interval [CI] 0.67-1.06). There was no significant heterogeneity in the overall analysis (P = .29). There was a significant reduction in preterm birth at less than 35 weeks in the cerclage group compared with the no-cerclage groups in singleton gestations (RR 0.74, 95% CI 0.57-0.96), singleton gestations with prior preterm birth (RR 0.61, 95% CI 0.40-0.92), and singleton gestations with prior second-trimester loss (RR 0.57, 95% CI 0.33-0.99). There was a significant increase in preterm birth at less than 35 weeks in twin gestations (RR 2.15, 95% CI 1.15-4.01).
Cerclage does not prevent preterm birth in all women with short cervical length on transvaginal ultrasonography. In the subgroup analysis of singleton gestations with short cervical length, especially those with a prior preterm birth, cerclage may reduce preterm birth, and a well-powered trial should be carried out in this group of patients. In contrast, in twins, cerclage was associated with a significantly higher incidence of preterm birth.
早产是围产期发病和死亡的主要原因。经阴道超声检查发现宫颈长度短可预测早产。我们的目的是通过对随机试验的荟萃分析来评估宫颈环扎术是否能预防宫颈长度短的女性发生早产。
使用“宫颈环扎术”“宫颈环扎”“宫颈短”“超声”和“随机试验”等检索词，对MEDLINE、PubMed、EMBASE和Cochrane图书馆进行了检索。我们纳入了涉及使用宫颈环扎术治疗经阴道超声检查发现宫颈长度短的女性的随机试验，并使用个体水平的数据。
制表、整合与结果：确定了四项实施得当的试验。在总人群中，宫颈环扎术组妊娠小于35周时的早产发生率为29.2%（89/305），未行宫颈环扎术组为34.8%（105/302）（相对危险度[RR]0.84，95%置信区间[CI]0.67 - 1.06）。总体分析中无显著异质性（P = 0.29）。与未行宫颈环扎术组相比，宫颈环扎术组单胎妊娠小于 35周时的早产有显著减少（RR 0.74，95% CI 0.57 - 0.96），有早产史的单胎妊娠（RR 0.61，95% CI 0.40 - 0.92），以及孕中期有流产史的单胎妊娠（RR 0.57，95% CI 0.33 - 0.99）。双胎妊娠小于35周时的早产有显著增加（RR 2.15，95% CI 1.15 - 4.01）。
宫颈环扎术并不能预防所有经阴道超声检查发现宫颈长度短的女性发生早产。在宫颈长度短的单胎妊娠亚组分析中，尤其是有早产史的那些，宫颈环扎术可能会减少早产，应该对这组患者进行一项样本量充足的试验。相比之下，在双胎妊娠中，宫颈环扎术与早产发生率显著升高相关。
