Wei Minling, Jin Xiaoying, Li T C, Yang Cuiyu, Huang Dong, Zhang Songying
Assisted Reproduction Unit, Department of Obstetrics and Gynecology, School of Medicine, Sir Run Run Shaw Hospital, Zhejiang University, Key Laboratory of Reproductive Dysfunction Management of Zhejiang Province, 3# Qingchun East Road, Hangzhou, 310016, People's Republic of China.
Department of Obstetrics and Gynecology, Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong, People's Republic of China.
Arch Gynecol Obstet. 2018 Mar;297(3):645-652. doi: 10.1007/s00404-017-4636-x. Epub 2018 Jan 4.
To compare the pregnancy outcome of the modified transvaginal cerclage performed preconception and during pregnancy.
A retrospective trial was carried out in the Department of Obstetrics and Gynecology, Sir Run Run Shaw Hospital in Zhejiang, China. A total of 604 women with cervical incompetence underwent the cerclage, and the time of the operation was decided by the patients or depended on when the patient presented. Main outcome measures were the gestational age and the fetal outcome.
After the cerclage, the mean gestational age at delivery and the term delivery rate were significantly higher in history-indicated conception cerclage compared to preconception cerclage (36.8 ± 3.7 vs 35.8 ± 4.7, p < 0.01; 76.1 vs 66.9%, p < 0.05). The mean gestational age at delivery and the term delivery rate were significantly higher in ultrasound-indicated compared to physical examination-indicated conception cerclage (35.0 ± 5.7 vs 31.0 ± 5.5, p < 0.01; 63.2 vs 23.3%, p < 0.001). The fetal survival rate had no difference in these two comparisons, respectively.
The modified transvaginal cervicoisthmic cerclage is a promising and safe technique to improve obstetric outcomes in women with cervical incompetence in different cerclage indications, and history-indicated conception cerclage appears to have better pregnancy outcome.
比较孕前和孕期进行改良经阴道宫颈环扎术的妊娠结局。
在中国浙江邵逸夫医院妇产科进行了一项回顾性试验。共有604例宫颈机能不全的妇女接受了环扎术，手术时间由患者决定或取决于患者就诊时间。主要观察指标为孕周和胎儿结局。
环扎术后，既往有指征受孕环扎术与孕前环扎术相比，平均分娩孕周和足月分娩率显著更高（36.8±3.7 vs 35.8±4.7，p<0.01；76.1% vs 66.9%，p<0.05）。超声指征受孕环扎术与体格检查指征受孕环扎术相比，平均分娩孕周和足月分娩率显著更高（35.0±5.7 vs 31.0±5.5，p<0.01；63.2% vs 23.3%，p<0.001）。在这两项比较中，胎儿存活率分别无差异。
改良经阴道宫颈峡部环扎术是一种有前景且安全的技术，可改善不同环扎指征的宫颈机能不全妇女的产科结局，既往有指征受孕环扎术似乎有更好的妊娠结局。
