Obstetrics and Gynaecology Department, Sunshine Hospital, Melbourne, Australia.
Biomed Res Int. 2018 Sep 30;2018:2065232. doi: 10.1155/2018/2065232. eCollection 2018.
One of the biggest obstetric challenges is the diagnosis and management of a short cervix as cervical length has an inverse relationship with risk of preterm birth. A cervical cerclage is a surgical procedure to reduce the risk of preterm birth and can be placed in an elective or emergency setting. This is a retrospective review of cervical cerclages inserted at an outer metropolitan hospital from February 2014 to May 2017. Since the introduction of the service, a total of 43 patients were identified as requiring a cervical cerclage. Four of these patients were transferred to tertiary hospitals. Of the 39 cerclages inserted, 26 were elective and 13 were emergency, placed at a mean gestation of 15.6 and 19.6 weeks. In total, there were 35 live births, 2 stillbirths, and 2 neonatal deaths. The maternal demographics (age, gravidity, parity, and preterm risk factors) were not statistically significant between the two groups. The mean pregnancy prolongation and birthweight was greater in the elective than the emergency group (21.4 versus 14.1 weeks; 3148.2 versus 2447.2 grams). There was no obvious pattern with which patients received antibiotics pre-, intra-, or postoperatively or received a vaginal swab. This audit identified the need for improvements to guidelines to standardise the use of antibiotics and progesterone in women with a cervical cerclage.
产科面临的最大挑战之一是诊断和处理短宫颈，因为宫颈长度与早产风险呈反比。宫颈环扎术是一种降低早产风险的手术，可以在择期或紧急情况下进行。这是对 2014 年 2 月至 2017 年 5 月在一家远郊医院进行的宫颈环扎术的回顾性研究。自该服务推出以来，共有 43 名患者被确定需要进行宫颈环扎术。其中 4 名患者转至三级医院。在插入的 39 个宫颈环扎术中，26 个为择期，13 个为紧急，分别在平均妊娠 15.6 和 19.6 周时进行。共有 35 例活产，2 例死产和 2 例新生儿死亡。两组的产妇人口统计学数据（年龄、孕次、产次和早产危险因素）无统计学差异。择期组的妊娠延长和出生体重均大于紧急组（21.4 周 vs. 14.1 周；3148.2 克 vs. 2447.2 克）。术前、术中或术后使用抗生素以及进行阴道拭子检查的患者没有明显的模式。这项审计确定需要改进指南，以标准化在接受宫颈环扎术的女性中使用抗生素和孕激素。
