Fick Andrea L, Caughey Aaron B, Parer Julian T
Department of Obstetrics and Gynecology, University of Iowa, Iowa City, IA 52242-1080, USA.
J Matern Fetal Neonatal Med. 2007 Jan;20(1):63-7. doi: 10.1080/14767050601059156.
To examine the outcome of pregnancies in women with transabdominal cerclage (TAC) and to determine whether aspects of the obstetric history predict failure.
This was a cohort study of pregnant women referred for a transabdominal cerclage between 1978 and 2004. Records were reviewed for obstetric history and maternal demographics. Predictor variables were prior pregnancy loss, prior vaginal cerclage, associated factors for TAC, and maternal age. The outcome variable was delivery of an infant beyond 24 weeks who survived the neonatal period. Outcomes were compared using Student's t-test, standard z-test, and Chi-square test.
Eighty-eight women delivered 96 pregnancies after TAC placement. The fetal salvage rate prior to TAC was 18%, 93% after the procedure (p<0.001). Delivery beyond 37 weeks occurred in 70% of pregnancies. Maternal age, prior cerclage history, associated factors for TAC, or previous delivery of a viable infant did not predict the eight failures out of the 96 pregnancies.
Women with TAC had a higher rate of successful pregnancies than prior to TAC. Neither maternal age nor prior pregnancy loss predicted failure. However with such a high success rate, we would have needed 948 women to do so. TAC is an option for women with a poor obstetric history including failed vaginal cerclage.
探讨经腹宫颈环扎术（TAC）治疗孕妇的妊娠结局，并确定产科病史的某些方面是否可预测手术失败。
这是一项对1978年至2004年间接受经腹宫颈环扎术的孕妇进行的队列研究。回顾记录以了解产科病史和产妇人口统计学资料。预测变量包括既往妊娠丢失、既往阴道环扎术、TAC的相关因素以及产妇年龄。结局变量为孕周超过24周且新生儿期存活的婴儿分娩情况。采用学生t检验、标准z检验和卡方检验比较结局。
88名妇女在接受TAC术后分娩了96次妊娠。TAC术前胎儿挽救率为18%，术后为93%（p<0.001）。70%的妊娠孕周超过37周。产妇年龄、既往环扎术史、TAC的相关因素或既往活产史均不能预测96次妊娠中的8次失败情况。
接受TAC治疗的妇女妊娠成功率高于TAC术前。产妇年龄和既往妊娠丢失均不能预测手术失败。然而，鉴于如此高的成功率，我们需要948名妇女才能进行相关预测。对于产科病史不佳（包括阴道环扎术失败）的妇女，TAC是一种选择。
