J Perinat Med. 2014 Jan;42(1):55-9. doi: 10.1515/jpm-2013-0092.
The objective of this study was to compare modified Shirodkar cerclage to bed rest for treatment of the midtrimester extremely short cervix.
This study used a concurrent retrospective cohort design at two institutions over the same period, 2000-2010. Patients were included at both institutions when midtrimester endovaginal ultrasound cervical length was ≤ 15 mm and had modified Shirodkar cerclage (cerclage group) at New York Hospital Queens and bed rest (control group) at Weill Cornell Medical Center. Cerclage was placed as high on the cervix as possible. Indomethacin and antibiotics were used perioperatively.
The cerclage group included 112 patients and the control group included 55 patients. Median postoperative cervical length in the cerclage group was 3.3 cm (interquartile range 3.0-3.6). Cerclage patients were less likely to deliver preterm at 37, 35, 32, and 28 weeks (P=0.0066, 0.0004, 0.0023, and 0.03 respectively) and had longer latency (median 120 vs. 94 days P<0.0001). Kaplan-Meier survival curve showed a significant benefit in favor of cerclage (P=0.0043).
Our data suggest that modified Shirodkar cerclage as high as possible on the cervix with perioperative indomethacin and antibiotics is superior to bed rest for treatment of the midtrimester extremely short cervix (≤15 mm). We propose a randomized trial of this specific technique.
本研究旨在比较改良 Shirodkar 环扎术与卧床休息治疗中孕期极短宫颈的疗效。
本研究采用了两所医院同期的回顾性队列研究设计，时间为 2000 年至 2010 年。当两所医院的中孕期经阴道超声宫颈长度≤15mm 时，纳入患者并进行改良 Shirodkar 环扎术（环扎组），在纽约皇后医院进行，而在威尔康奈尔医疗中心则进行卧床休息（对照组）。环扎术尽可能高的环扎宫颈。围手术期使用吲哚美辛和抗生素。
环扎组包括 112 例患者，对照组包括 55 例患者。环扎组术后宫颈长度中位数为 3.3cm（四分位距 3.0-3.6）。环扎组患者在 37、35、32 和 28 周时早产的可能性较低（P=0.0066、0.0004、0.0023 和 0.03），潜伏期更长（中位数 120 天 vs. 94 天，P<0.0001）。Kaplan-Meier 生存曲线显示环扎术有显著优势（P=0.0043）。
我们的数据表明，尽可能高的宫颈改良 Shirodkar 环扎术，联合围手术期使用吲哚美辛和抗生素，优于卧床休息治疗中孕期极短宫颈（≤15mm）。我们建议对此种特定技术进行随机试验。
