Vousden Nicola, Hezelgrave Natasha, Carter Jenny, Seed Paul T, Shennan Andrew H
Division of Women's Health, Women's Health Academic Centre, and Maternal and Fetal Research Unit, King's College London, Division of Reproduction and Endocrinology, St Thomas' Hospital, London SE1 7EH UK.
Division of Women's Health, Women's Health Academic Centre, and Maternal and Fetal Research Unit, King's College London, Division of Reproduction and Endocrinology, St Thomas' Hospital, London SE1 7EH UK.
Eur J Obstet Gynecol Reprod Biol. 2015 May;188:129-32. doi: 10.1016/j.ejogrb.2015.02.007. Epub 2015 Feb 16.
To determine the subsequent need for cerclage and pregnancy outcome, in women with a prior ultrasound-indicated cerclage.
Analysis of a prospectively collected database from November 2010 to July 2014 from 15 Preterm Surveillance clinics across the UK was performed. Women with an index and previous singleton pregnancy with an ultrasound-indicated cerclage were eligible for inclusion (n=55). Previous ultrasound-indicated cerclage was defined as cerclage inserted prior to 24 weeks' for cervical length <25 mm as detected by transvaginal ultrasound. Women were managed in their subsequent pregnancy with either history-indicated cerclage, transvaginal ultrasound surveillance of cervical length with cerclage if <25 mm or transabdominal cerclage at the discretion of the physician. Exact logistic regression was used to estimate the odds ratio on the chance of delivery before 34 weeks'. Adjustments were made for major risk factors for prematurity: previous spontaneous preterm birth, previous late miscarriage (16+0 to 23+6 weeks') and previous cervical surgery; both individually and in combination.
Of the 55 eligible women, 23 underwent history-indicated cerclage, 23 underwent transvaginal ultrasound cervical length surveillance and 8 underwent abdominal cerclage in the index pregnancy. Of those that had ultrasound surveillance, 13 (57%) did not require cerclage and all delivered after 34 weeks'. Of those that had a history-indicated cerclage, six delivered before 34 weeks'. Therefore, women that received a history-indicated cerclage had greater risk of preterm birth compared to women that underwent ultrasound surveillance with cerclage insertion only if cervical shortening was detected (OR 0.09 95% CI 0.00-0.74, p=0.02). Adjustments for risk factors for preterm birth did not significantly affect this risk.
In women with prior ultrasound-indicated cerclage, who undergo cervical surveillance in the next pregnancy, the majority will not require intervention for a short cervix. Those women receiving a history-indicated vaginal cerclage were more likely to deliver preterm; this cannot be explained by their risk status. All women receiving an abdominal elective cerclage had good outcomes. Ultrasound surveillance is appropriate in women with a prior ultrasound-indicated cerclage who do not require an abdominal cerclage.
确定既往超声提示需行宫颈环扎术的女性后续对宫颈环扎术的需求及妊娠结局。
对2010年11月至2014年7月期间从英国15家早产监测诊所前瞻性收集的数据库进行分析。纳入标准为有索引妊娠且既往为单胎妊娠、超声提示需行宫颈环扎术的女性（n = 55）。既往超声提示宫颈环扎术定义为经阴道超声检测宫颈长度<25 mm时在24周前进行的宫颈环扎术。这些女性在后续妊娠中接受以下管理：根据病史行宫颈环扎术、经阴道超声监测宫颈长度，若宫颈长度<25 mm则行宫颈环扎术或由医生酌情行腹式宫颈环扎术。采用精确逻辑回归分析估计34周前分娩几率的比值比。对早产的主要危险因素进行调整：既往自发性早产、既往晚期流产（16 + 0至23 + 6周）和既往宫颈手术；单独及联合调整。
55例符合条件的女性中，23例行根据病史的宫颈环扎术，23例行经阴道超声宫颈长度监测，8例行索引妊娠腹式宫颈环扎术。在接受超声监测的女性中，13例（57%）不需要宫颈环扎术，且均在34周后分娩。在接受根据病史的宫颈环扎术的女性中，6例在34周前分娩。因此，与仅在检测到宫颈缩短时才接受超声监测并行宫颈环扎术的女性相比，接受根据病史的宫颈环扎术的女性早产风险更高（比值比0.09，95%可信区间0.00 - 0.74，p = 0.02）。对早产危险因素的调整并未显著影响该风险。
对于既往超声提示需行宫颈环扎术且下次妊娠接受宫颈监测的女性，大多数不会因宫颈短而需要干预。那些接受根据病史的阴道宫颈环扎术的女性更易早产；这无法用其风险状况来解释。所有接受择期腹式宫颈环扎术的女性结局良好。对于既往超声提示需行宫颈环扎术且不需要腹式宫颈环扎术的女性，超声监测是合适的。
