Liu Yanyan, Ke Zikan, Liao Wanmin, Chen Hanping, Wei Shiqing, Lai Xiaoquan, Chen Xi
Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, People's Republic of China.
School of Foreign Languages, Huazhong University of Science and Technology, Wuhan, 430074, People's Republic of China.
Arch Gynecol Obstet. 2018 Jun;297(6):1503-1508. doi: 10.1007/s00404-018-4766-9. Epub 2018 Apr 7.
To compare the clinical effect of prophylactic cervical cerclage and therapeutic cervical cerclage on pregnancy outcome and operative factors in cervical insufficiency pregnant women.
A retrospective study was conducted between June 2014 and September 2016 in a maternity ward, which included women who have had a single pregnancy and have been carried out a McDonald cerclage. All maternal medical records were reviewed. The efficacy of cerclage for preventing late foetal loss was assessed using multivariable logistic regression analysis.
The results showed that there were significant associations between cerclage operations and pregnancy outcomes in the duration of pregnancy prolongation in terms of live births, gestation age, live birth and cesarean section rate. In prophylactic cervical cerclage, compared with therapeutic cervical cerclage, cervical length before surgery was significantly longer (32.7 ± 5.8 vs 19.9 ± 7.3 mm, p < 0.0001). Mean operative duration and postoperative length of hospital stay in prophylactic cervical cerclage were shorter than those in therapeutic cervical cerclage (22.1 ± 10.3 vs 28.9 ± 13.0 min, p = 0.0241 and 5.6 ± 1.8 vs 7.0 ± 2.8 days, p = 0.0354), respectively. Compared with therapeutic cerclage, prophylactic cerclage had more advantages in gestational age at delivery (35.2 ± 5.5 and 31.7 ± 6.5 weeks, p = 0.0061), deliveries < 37 gestational weeks (40 vs 69.2%, p = 0.0159), live births (93.3 vs 69.2%, p = 0.0143) and the duration of pregnancy prolongation in terms of live births (19.5 ± 5.0 vs 12.0 ± 8.2 weeks, p = 0.0002). There was a higher cesarean section rate in prophylactic group than that in therapeutic group (50 vs 25.6%, p = 0.0383). The logistic analysis showed that the cervical length before surgery was the only independent prognostic factor [OR 2.860 (1.425, 5.742) p = 0.0031] for pregnancy outcome, and that is the cervical length before surgery affected late foetal loss.
Our study suggests that, both prophylactic cervical cerclage and therapeutic cervical cerclage reduce the incidence of recurrent abortion or preterm birth and efficiently extend the length of the pregnancy with live births. The prophylactic cervical cerclage has more advantages in operative time, length of hospital stay after surgery, gestational age at delivery, live births and preterm birth. The length of the cervical before surgery is an independent risk factor for pregnancy outcomes when pregnant women appear in the cervical shortening is less than normal. Cervical cerclage is an effective surgical technique to prevent recurrent abortion or late foetal loss.
比较预防性宫颈环扎术和治疗性宫颈环扎术对宫颈机能不全孕妇妊娠结局及手术相关因素的临床效果。
2014年6月至2016年9月在某产科病房进行一项回顾性研究，纳入单胎妊娠且接受麦克唐纳宫颈环扎术的女性。查阅所有产妇的病历。采用多变量逻辑回归分析评估宫颈环扎术预防晚期胎儿丢失的疗效。
结果显示，在活产、孕周、活产率及剖宫产率方面，宫颈环扎术与妊娠结局在延长妊娠时间方面存在显著关联。在预防性宫颈环扎术中，与治疗性宫颈环扎术相比，术前宫颈长度显著更长（32.7±5.8 vs 19.9±7.3mm，p<0.0001）。预防性宫颈环扎术的平均手术时间和术后住院时间短于治疗性宫颈环扎术（分别为22.1±10.3 vs 28.9±13.0分钟，p = 0.0241；5.6±1.8 vs 7.0±2.8天，p = 0.0354）。与治疗性环扎术相比，预防性环扎术在分娩孕周（35.2±5.5和31.7±6.5周，p = 0.0061）、<37孕周分娩（40% vs 69.2%，p = 0.0159）、活产率（93.3% vs 69.2%，p = 0.0143）以及活产情况下的妊娠延长时间（19.5±5.0 vs 12.0±8.2周，p = 0.0002）方面具有更多优势。预防性组的剖宫产率高于治疗性组（50% vs 25.6%，p = 0.0383）。逻辑分析表明，术前宫颈长度是妊娠结局的唯一独立预后因素[OR 2.860（1.425，5.742）p = 0.0031]，即术前宫颈长度影响晚期胎儿丢失。
我们的研究表明，预防性宫颈环扎术和治疗性宫颈环扎术均可降低复发性流产或早产的发生率，并有效延长活产的妊娠时间。预防性宫颈环扎术在手术时间、术后住院时间、分娩孕周、活产率及早产方面具有更多优势。当孕妇出现宫颈缩短且短于正常时，术前宫颈长度是妊娠结局的独立危险因素。宫颈环扎术是预防复发性流产或晚期胎儿丢失的有效手术技术。
