Gundabattula Sirisha Rao, Marakani Lakshmi Rathna, Dasari Shashikala, Surampudi Kameswari, Pochiraju Manjula, Nirmalan Praveen Kumar
Department of Gynaecology, Fernandez Hospital, Hyderabad, India.
J Obstet Gynaecol Res. 2013 Aug;39(8):1293-300. doi: 10.1111/jog.12059. Epub 2013 Jun 26.
The aim of this study was to evaluate outcome of pregnancies in women with rescue cerclage for cervical insufficiency.
A retrospective study of all women who underwent rescue cerclage between 2002 and 2011 at an advanced tertiary care perinatal institute in India was conducted. Data retrieved from medical records was used to explore potential associations with prolongation of pregnancy beyond 28 weeks.
The mean (standard deviation) gestational age at cerclage was 21.9 (2.7) weeks for the 74 women in the study. The McDonald technique was the preferred method for rescue cerclage (91.9%). All women received antibiotics; tocolytics were used in 35.1% and progesterones in 62.2% of women. The mean prolongation of pregnancy was 7.4 weeks with 42.0% women delivering after 28 weeks and 30.4% after 34 weeks. The take-home-baby rate was 50.7% (95% confidence interval: 38.7-62.6%). Postoperative vaginal infection was present in 16.2% of women, preterm premature rupture of membranes in 31.1% of women and neonatal sepsis in 5.8% of neonates. Cerclage placement after 20 weeks and negative pathogenic organisms in vaginal swab culture were significantly associated with delivery beyond 28 weeks.
Although half of the women had successful pregnancy outcomes after rescue cerclage, pregnancy extended from previability to prematurity in most of them.
本研究旨在评估因宫颈机能不全接受补救性宫颈环扎术的女性的妊娠结局。
对2002年至2011年期间在印度一家高级三级围产医学机构接受补救性宫颈环扎术的所有女性进行回顾性研究。从医疗记录中检索的数据用于探索与妊娠延长至28周以上的潜在关联。
本研究中的74名女性进行宫颈环扎术时的平均（标准差）孕周为21.9（2.7）周。麦克唐纳技术是补救性宫颈环扎术的首选方法（91.9%）。所有女性均接受了抗生素治疗；35.1%的女性使用了宫缩抑制剂，62.2%的女性使用了孕激素。妊娠平均延长7.4周，42.0%的女性在28周后分娩，30.4%的女性在34周后分娩。活产率为50.7%（95%置信区间：38.7 - 62.6%）。16.2%的女性术后出现阴道感染，31.1%的女性发生胎膜早破，5.8%的新生儿发生败血症。20周后进行宫颈环扎术以及阴道拭子培养中无致病微生物与28周后分娩显著相关。
尽管一半的女性在补救性宫颈环扎术后获得了成功的妊娠结局，但大多数女性的妊娠从未成熟延长至早产。
