Hamou Batel, Sheiner Eyal, Coreanu Tara, Walfisch Asnat, Silberstein Tali
Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
Department of Medicine and Clinical Research Center, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
J Matern Fetal Neonatal Med. 2020 Mar;33(5):883-887. doi: 10.1080/14767058.2018.1505852. Epub 2018 Sep 7.
To investigate the significance of intrapartum cervical lacerations on subsequent pregnancies. A retrospective cohort analysis was conducted, comparing outcomes of subsequent singleton pregnancies, in women with and without a history of cervical lacerations in a previous delivery. Deliveries occurred between the years 1991-2014 at the Soroka University Medical Center. Multiple logistic regression models were constructed to control for clinically significant confounders. During the study period 187,162 deliveries met the inclusion criteria. Of them, 429 (0.2%) occurred in women with a history of cervical lacerations in the previous pregnancy (study group). The study group exhibited significantly higher rates of recurrent cervical lacerations (21/429, 4.9% versus 275/187 162,0.1%, value = .001), cerclage (13/429, 3% versus 260/187 162, 0.1% value = .001), cervical incompetence (8/429, 1.9% versus 609/187 162, 0.3% value = .001) cesarean delivery (CD) (97/429, 22.6% versus 26 280/187 162,14%, value = .001), severe perineal tears (third or fourth degree; 2/429, 0.5%, versus 164/187 162, 0.1%, value = .056) and blood transfusion (11/429, 2.6% versus 2448/187 162, 1.3%, value = .022) as compared with the comparison group. Using a multivariable logistic regression model, history of cervical laceration in a previous pregnancy was found to be an independent risk factor for subsequent CD (OR 1.4, 95% CI 1.1-1.9), recurrent cervical laceration (OR 29.3, 95% CI 17.7-48.5), severe perineal lacerations (OR 11.7, 95% CI 5.1-27.2), and preterm delivery (OR 1.8, 95% CI 1.1-2.8) in the subsequent pregnancy. A history of intrapartum cervical laceration is an independent risk factor for recurrent cervical lacerations, CD, preterm delivery, and severe perineal lacerations in the subsequent pregnancy.
为研究产时宫颈裂伤对后续妊娠的影响。我们进行了一项回顾性队列分析，比较既往有或无宫颈裂伤史的女性后续单胎妊娠的结局。分娩发生在1991年至2014年期间的索罗卡大学医学中心。构建了多个逻辑回归模型以控制具有临床意义的混杂因素。在研究期间，187162例分娩符合纳入标准。其中，429例（0.2%）发生在既往妊娠有宫颈裂伤史的女性中（研究组）。与对照组相比，研究组复发性宫颈裂伤（21/429，4.9% 对比 275/187162，0.1%，P值 = 0.001）、宫颈环扎术（13/429，3% 对比 260/187162，0.1%，P值 = 0.001）、宫颈机能不全（8/429，1.9% 对比 609/187162，0.3%，P值 = 0.001）、剖宫产（CD）（97/429，22.6% 对比 26280/187162，14%，P值 = 0.001）、严重会阴裂伤（三度或四度；2/429，0.5%，对比 164/187162，0.1%，P值 = 0.056）及输血（11/429，2.6% 对比 2448/187162，1.3%，P值 = 0.022）的发生率显著更高。使用多变量逻辑回归模型发现，既往妊娠宫颈裂伤史是后续妊娠发生CD（比值比1.4，95%可信区间1.1 - 1.9）、复发性宫颈裂伤（比值比29.3，95%可信区间17.7 - 48.5）、严重会阴裂伤（比值比11.7，95%可信区间5.1 - 27.2）及早产（比值比1.8，95%可信区间1.1 - 2.8）的独立危险因素。产时宫颈裂伤史是后续妊娠复发性宫颈裂伤、剖宫产、早产及严重会阴裂伤的独立危险因素。
