Simcox Rachael, Shennan Andrew
Maternal and Fetal Research Unit, Division of Reproduction and Endocrinology, King's College London, St. Thomas' Hospital, London, UK.
Aust N Z J Obstet Gynaecol. 2012 Jun;52(3):224-8. doi: 10.1111/j.1479-828X.2012.01440.x. Epub 2012 Apr 26.
Transvaginal ultrasound measurement of cervical length is useful after suture insertion in predicting preterm delivery. However, there is little evidence to guide practice in the clinical scenario when fetal membranes are seen on ultrasound to be prolapsing distal to a cervical suture.
To determine whether a reinforcing cerclage reduced preterm delivery in those women with ultrasound evidence of fetal membranes prolapsing distal to the first suture.
A retrospective cohort study was conducted on women with a cervical suture in situ plus ultrasound evidence of fetal membranes prolapsing through the first suture. Exposed patients were those managed with a reinforcing cerclage. The unexposed group were women who were managed expectantly, without a reinforcing cerclage.
Those women with a reinforcing cerclage were significantly more likely to deliver at an earlier gestation compared with those managed expectantly: 26(+0) (±5(+1) ) compared with 31(+1) (±7(+0) ) weeks, P = 0.047. More women in the reinforcing cerclage group delivered at <32 completed weeks' gestation: 12/13 (92%) versus 5/12 (42%), P = 0.01. There was no significant difference in the rate of second-trimester miscarriages between the expectant management group and those with a reinforcing cerclage: 2/12 (17%) versus 5/13 (38%), P = 0.38.
Our study found that a reinforcing cerclage following primary cerclage failure hastened preterm delivery. The role of transvaginal ultrasound measurement of cervical length postsuture is debatable if the possible intervention is not beneficial and may be detrimental.
宫颈环扎术后经阴道超声测量宫颈长度有助于预测早产。然而，在超声检查发现胎膜脱垂至宫颈缝线远端的临床情况下，几乎没有证据可指导实践。
确定在有超声证据显示胎膜脱垂至第一道缝线远端的女性中，再次环扎是否能降低早产率。
对宫颈已行环扎且超声显示胎膜经第一道缝线脱垂的女性进行回顾性队列研究。暴露组患者接受再次环扎治疗。未暴露组为仅接受观察等待、未行再次环扎的女性。
与仅接受观察等待的女性相比，接受再次环扎的女性更早分娩的可能性显著更高：分别为26（+0）（±5（+1））周和31（+1）（±7（+0））周，P = 0.047。再次环扎组更多女性在妊娠满32周前分娩：12/13（92%）对比5/12（42%），P = 0.01。观察等待组与再次环扎组在孕中期流产率方面无显著差异：2/12（17%）对比5/13（38%），P = 0.38。
我们的研究发现，初次环扎失败后再次环扎会加速早产。如果可能的干预措施无益处甚至可能有害，那么宫颈环扎术后经阴道超声测量宫颈长度的作用就存在争议。
