Diamant Hagit, Mastrolia Salvatore Andrea, Weintraub Adi Y, Sheizaf Boaz, Zilberstein Tali, Yohay David
a Department of Obstetrics and Gynecology, Faculty of Health Sciences , Soroka University Medical Center, Ben-Gurion University of the Negev , Be'er Sheva , Israel.
J Matern Fetal Neonatal Med. 2019 Sep;32(18):3007-3011. doi: 10.1080/14767058.2018.1454426. Epub 2018 Apr 10.
To evaluate the safety and effectiveness of late cervical cerclage performed beyond 17 weeks of gestation. The outcomes of interest were effectiveness of late cerclage in prolongation of pregnancy and evaluation of pregnancy outcome including maternal and fetal complications. A total of 30 patients underwent late cervical cerclage during the study period. Of them, two were twin pregnancies. A late cerclage was performed after the diagnosis of cervical shortening or dilatation in 20 patients. We performed a retrospective case series review. One case was lost to follow up (delivery in another medical center). Medical information was retrieved from all cases of patients who underwent a late cervical cerclage between the years 2010 and 2016 at the Soroka University Medical Center, a tertiary medical center. Continuous variables were expressed as mean ± standard deviation. Categorical variables were expressed as proportions. The average gestational age at birth was 35 ± 5.1 weeks of gestation. The mean interval between cerclage and delivery in the study population was 17 ± 5.62 weeks. Nine cases (32.1%) resulted in preterm deliveries, three of them below 34 weeks of gestation (one twin pregnancy and two pregnancies diagnosed with cervical dilation prior to cerclage). Among all the preterm deliveries, there were four cases of preterm prelabor rupture of membranes (13.3%). Of the 28 deliveries, 24 women (85.7%) had a vaginal delivery, while four women (14.3%) underwent a cesarean section. No cases of cervical tear were described. The cerclage was sent to bacteriology after removal, showing positive cultures for Candida species in nine cases (31%). In our study population, late cervical cerclage was found to be a safe procedure resulting in almost 90% of successful vaginal deliveries without maternal or fetal complications. This procedure might be effective in the prolongation of pregnancy in women with cervical dynamics in the late second trimester.
评估妊娠17周后进行晚期宫颈环扎术的安全性和有效性。关注的结果是晚期宫颈环扎术延长妊娠的有效性以及对妊娠结局的评估，包括母体和胎儿并发症。在研究期间，共有30例患者接受了晚期宫颈环扎术。其中，2例为双胎妊娠。20例患者在诊断为宫颈缩短或扩张后进行了晚期宫颈环扎术。我们进行了一项回顾性病例系列研究。1例失访（在另一家医疗中心分娩）。从索罗卡大学医学中心（一家三级医疗中心）2010年至2016年间接受晚期宫颈环扎术的所有患者病例中获取医疗信息。连续变量以均值±标准差表示。分类变量以比例表示。出生时的平均孕周为35±5.1周。研究人群中环扎术与分娩之间的平均间隔为17±5.62周。9例（32.1%）发生早产，其中3例孕周低于34周（1例双胎妊娠，2例在环扎术前诊断为宫颈扩张的妊娠）。在所有早产病例中，有4例发生早产前胎膜早破（13.3%）。在28例分娩中，24名女性（85.7%）经阴道分娩，4名女性（14.3%）接受了剖宫产。未描述宫颈撕裂病例。环扎术取出后送去做细菌学检查，9例（31%）念珠菌属培养结果呈阳性。在我们的研究人群中，晚期宫颈环扎术被发现是一种安全的手术，近90%的患者成功经阴道分娩，无母体或胎儿并发症。该手术可能对妊娠中期晚期宫颈动态变化的女性延长妊娠有效。
