Deffieux X, de Tayrac R, Louafi N, Gervaise A, Sénat M-V, Chauveaud-Lambling A, Picone O, Faivre E, Bonnet K, Frydman R, Fernandez H
Service de Gynécologie Obstétrique, Hôpital Antoine-Béclère, 157, rue de la Porte-de-Trivaux, 92140 Clamart.
J Gynecol Obstet Biol Reprod (Paris). 2006 Sep;35(5 Pt 1):465-71. doi: 10.1016/s0368-2315(06)76418-3.
To assess the efficacy of performing transvaginal cervico-isthmic cerclage using synthetic tape in prevention of preterm labor in high-risk women.
A retrospective analysis of 24 transvaginal cerclages using polypropylene tape performed in women presenting with high risk of preterm delivery: prior histories of pregnancy losses in the second trimester, prior failure of Mac Donald's cerclage and/or absent portio vaginalis of the cervix. Cerclage was performed between 12 and 16 weeks of gestation. A polypropylene tape was placed at the cervicoisthmic junction by vaginal route.
The median age of the patients in this series was 32.1 years (range 22-39 years). No intra-operative complication occurred. The median operating time was 34.9 minutes (+/-5.1) (range 30-45 min). Cesarean delivery was systematically performed in all patients since the cerclage was considered to be definitive. Mean gestational age and birth weight at delivery were respectively 37.1 weeks (+/-1.8) and 2850 g (+/-745). Preterm birth rate was 19% (4/21). Birth at less than 32 weeks occurred in only one patient (4%). In one case, the tape has been removed later because symptomatic vaginal erosion was noted. One neonatal death occurred following amniotic fluid infection at 34 weeks. At the present time, 3 women are at 22, 26 and 26 weeks of gestation with no preterm labor.
Transvaginal cerclage using polypropylene tape may be considered as an effective and minimally invasive alternative to transabdominal cervico-isthmic cerclage in women presenting with high risk of preterm delivery.
评估使用合成带进行经阴道宫颈峡部环扎术预防高危女性早产的疗效。
对24例使用聚丙烯带进行经阴道环扎术的患者进行回顾性分析，这些患者均有早产高危因素：既往有孕中期流产史、既往麦克唐纳环扎术失败和/或宫颈阴道部缺失。环扎术在妊娠12至16周之间进行。通过阴道途径将聚丙烯带放置在宫颈峡部交界处。
该系列患者的中位年龄为32.1岁（范围22 - 39岁）。术中无并发症发生。中位手术时间为34.9分钟（±5.1）（范围30 - 45分钟）。由于认为环扎术是确定性的，所有患者均系统性地进行了剖宫产。分娩时的平均孕周和出生体重分别为37.1周（±1.8）和2850克（±745）。早产率为19%（4/21）。仅1例患者在32周前分娩（4%）。有1例因出现有症状的阴道糜烂，后来移除了带子。1例新生儿在34周时因羊水感染死亡。目前，3名女性分别处于妊娠22、26和26周，未发生早产。
对于有早产高危因素的女性，使用聚丙烯带进行经阴道环扎术可被视为经腹宫颈峡部环扎术的一种有效且微创的替代方法。
