Sneider Kirstine, Christiansen Ole Bjarne, Sundtoft Iben Blaabjerg, Langhoff-Roos Jens
Department of Clinical Research, North Region Hospital, Hjørring, Denmark.
Department of Obstetrics and Gynecology, Aalborg University Hospital, Aalborg, Denmark.
Arch Gynecol Obstet. 2017 Apr;295(4):859-866. doi: 10.1007/s00404-017-4315-y. Epub 2017 Feb 23.
To estimate the incidence of cervical insufficiency and compare recurrence rates of second trimester miscarriage/delivery in second and third pregnancies after prophylactic vaginal cerclage, abdominal cerclage, or no cerclage.
Retrospective chart review of a representative register-based sample of 621 women with a spontaneous second trimester miscarriage/delivery in the first pregnancy in Denmark (1997-2012). We used strict criteria for the diagnosis of cervical insufficiency. The outcome of subsequent pregnancies was described by treatment with prophylactic vaginal cerclage, abdominal cerclage, or no prophylactic cerclage. Women were followed until June 2015.
Of 621 women, 149 (24%) fulfilled the strict criteria of cervical insufficiency. Prophylactic treatment with abdominal cerclage (n = 20), vaginal cerclage (n = 59), and no prophylactic cerclage (n = 61) resulted in a second pregnancy ending before 28 weeks in 5, 30, and 72% (p < 0.001) and before 34 weeks in 10, 46, and 84% (p < 0.001), respectively. Take-home baby rate was 95% after abdominal cerclage, 73% after vaginal cerclage, and 33% after no cerclage. In a third pregnancy, abdominal cerclage (n = 47), vaginal cerclage (n = 38), and no cerclage (n = 8) resulted in pregnancy ending before 34 weeks of gestation in 2, 21, and 25%, respectively (p = 0.01).
Cervical insufficiency was diagnosed in 24% of women with an initial second trimester spontaneous miscarriage/delivery. In second and third pregnancies, recurrence rates were significantly lower after prophylactic vaginal or abdominal cerclage compared with no cerclage.
评估宫颈机能不全的发生率，并比较预防性阴道环扎术、腹部环扎术或不进行环扎术后，第二次和第三次妊娠中期流产/分娩的复发率。
对丹麦621名在首次妊娠时发生自发性妊娠中期流产/分娩的女性进行回顾性图表审查（1997 - 2012年）。我们采用严格的标准诊断宫颈机能不全。后续妊娠结局通过预防性阴道环扎术、腹部环扎术或不进行预防性环扎术来描述。对女性进行随访至2015年6月。
621名女性中，149名（24%）符合宫颈机能不全的严格标准。接受腹部环扎术（n = 20）、阴道环扎术（n = 59）和不进行预防性环扎术（n = 61）的预防性治疗后，第二次妊娠在28周前结束的比例分别为5%、30%和72%（p < 0.001），在34周前结束的比例分别为10%、46%和84%（p < 0.001）。腹部环扎术后活产率为95%，阴道环扎术后为73%，未环扎术后为33%。在第三次妊娠中，腹部环扎术（n = 47）、阴道环扎术（n = 38）和不进行环扎术（n = 8）导致妊娠在妊娠34周前结束的比例分别为2%、21%和25%（p = 0.01）。
在首次妊娠中期自发性流产/分娩的女性中，24%被诊断为宫颈机能不全。在第二次和第三次妊娠中，与不进行环扎术相比，预防性阴道或腹部环扎术后复发率显著降低。
