Department of Obstetrics and Gynecology, Faculty of Medicine, Mansoura University, Mansoura, Egypt.
Department of Obstetrics and Gynecology, Faculty of Medicine, Cairo University, Cairo, Egypt.
Int J Gynaecol Obstet. 2014 Mar;124(3):198-203. doi: 10.1016/j.ijgo.2013.08.021. Epub 2013 Dec 4.
Rescue cervical cerclage (RCC) is essentially a salvage procedure to prolong pregnancy in women with advanced cervical changes and prolapsed membranes in the second trimester. However, its effectiveness and safety remain controversial.
To provide a comprehensive review of the contemporary evidence on RCC and evaluate which treatment modalities can be offered to pregnant women based on the best available evidence.
A PubMed search of published studies on RCC and perinatal outcome was conducted using defined keywords.
Clinical studies were included with priority for level I evidence (randomized controlled trials [RCTs]) followed by other evidence levels.
Abstracts of 141 articles were screened and 40 articles were selected.
Evidence from retrospective and nonrandomized prospective trials shows a benefit of RCC. It may prolong pregnancy by an average of 4-5 weeks, with a 2-fold reduction in the chance of preterm birth before 34 weeks. A higher chance of failure is expected if cervical dilatation exceeds 4 cm or if membranes are bulging into the vagina.
The decision for an RCC should be individualized after comprehensive counseling by a senior obstetrician. Further research in the form of robust RCTs is recommended.
挽救性宫颈环扎术（RCC）本质上是一种补救性手术，用于延长中孕期宫颈变化和胎膜早破的女性的妊娠时间。然而，其有效性和安全性仍存在争议。
对 RCC 及围产结局的当代证据进行全面综述，并根据现有最佳证据评估可向孕妇提供哪些治疗方法。
使用定义的关键词在 PubMed 上对 RCC 和围产结局的已发表研究进行了检索。
纳入临床研究，优先考虑一级证据（随机对照试验[RCT]），其次是其他证据水平。
筛选了 141 篇文章的摘要，选择了 40 篇文章。
来自回顾性和非随机前瞻性试验的证据表明 RCC 具有益处。它可以平均延长 4-5 周的妊娠时间，使 34 周前早产的机会减少两倍。如果宫颈扩张超过 4 厘米或胎膜膨出进入阴道，预计失败的可能性会更高。
应在资深产科医生全面咨询后个体化决定是否进行 RCC。建议进一步开展稳健的 RCT 研究。
