Capmas Perrine, Letendre Irène, Leray Camille, Deffieux Xavier, Duminil Laura, Subtil Damien, Fernandez Hervé
Department of Obstetrics and Gynecology, Hôpital Bicêtre, GHU Sud, AP-HP, F-94276, Le Kremlin Bicêtre, France; Inserm, Research center in Epidemiology and population health (CESP), U1018, F-94276, Le Kremlin Bicêtre, France.
Department of Obstetrics and Gynecology, Hôpital Bicêtre, GHU Sud, AP-HP, F-94276, Le Kremlin Bicêtre, France.
Eur J Obstet Gynecol Reprod Biol. 2017 Sep;216:27-32. doi: 10.1016/j.ejogrb.2017.06.037. Epub 2017 Jun 27.
Compare preterm births before 30 weeks of gestation in women with a previous failed McDonald cerclage that benefit from another McDonald cerclage (or simplified Shirodkar cerclage) or a vaginal cervico-isthmic cerclage.
Women with a cerclage performed at the end of the first trimester of a singleton pregnancy with a previous failed prophylactic McDonald cerclage were included in this mutlicenric study involving four teaching hospitals. Comparisons between groups were done using a chi square test and a student t-test.
We enrolled130 women, 85 in the vaginal cervico-isthmic cerclage group and 45 in the classic cerclage group. There was no significant difference in the rate of delivery after 30 weeks of gestation (92 versus 93% p=0.75). However in the cervico isthmic cerclage, women were significantly older, presented more late foetal loss and fewer live children in the cervico-isthmic cerclage group. Rate of antenatal hospitalization andantenatal corticotherapy were significantly higher in the classic cerclage group (69% versus 46%, p<0.05 and 56% versus 29%, p<0.05).
Rate of delivery before 30 weeks of gestation was not significantly different between the two groups, but women in the vaginal cervico-isthmic cerclage group seem to be at higher risk for late foetal loss or premature delivery. This procedure generates less threatened premature delivery, thus, less hospitalization and antenatal corticotherapy. These arguments are important for women with previous pregnancy loss.
比较既往McDonald宫颈环扎失败的孕妇在妊娠30周前再次接受McDonald宫颈环扎术（或简化的Shirodkar宫颈环扎术）或阴道宫颈峡部环扎术的早产情况。
本多中心研究纳入了四家教学医院中，在单胎妊娠孕早期行宫颈环扎术且既往预防性McDonald宫颈环扎失败的孕妇。采用卡方检验和学生t检验进行组间比较。
我们纳入了130名女性，其中85名接受阴道宫颈峡部环扎术，45名接受经典宫颈环扎术。妊娠30周后的分娩率无显著差异（分别为92%和93%，p = 0.75）。然而，在宫颈峡部环扎组中，女性年龄显著更大，胎儿晚期丢失更多，存活子女更少。经典宫颈环扎组的产前住院率和产前皮质激素治疗率显著更高（分别为69%对46%，p < 0.05；56%对29%，p < 0.05）。
两组在妊娠30周前的分娩率无显著差异，但阴道宫颈峡部环扎组的女性似乎胎儿晚期丢失或早产的风险更高。该手术导致的先兆早产更少，因此住院和产前皮质激素治疗也更少。这些观点对既往有流产史的女性很重要。
