2nd Department of Obstetrics and Gynaecology, Omsk State Medical University, Omsk, Russia.
Department of Obstetrics and Gynecology named after Professor G.A. Ushakova, Kemerovo State Medical University, Kemerovo, Russia.
J Matern Fetal Neonatal Med. 2021 Jul;34(13):2071-2079. doi: 10.1080/14767058.2019.1656195. Epub 2019 Sep 3.
To identify risk factors and predictors of pregnancy loss and to compare the efficacy of Arabin's pessary with cervical cerclage in women at a high risk of pregnancy loss.
This was a two-center retrospective case-control study that included 240 women at a high risk of preterm delivery. Group I ( = 161) included women who underwent insertion of the Arabin's pessary between 14 and 24 weeks of pregnancy. Group II ( = 79) included women who had undergone circular cervical cerclage during the current pregnancy. All women included in the study received micronized vaginal progesterone at the dose of 200 mg/day until and including 34 weeks of gestation.
Threatened pregnancy loss defined as spotting or vaginal bleeding in the first trimester was diagnosed in 29.8% (48/161) of patients in Group I versus 37.9% in Group II ( = .448). Postpartum bleeding occurred in 8.1% (13/161) in women in Group I versus 22.8% in Group II ( = 6.500; = .011). Our study showed that cervical cerclage was most suitable for patients with history of obstetric complications, cervical length <15 mm, and large isthmic uterine fibroids. The use of the Arabin's pessary reduced the rate of preterm births by 1.7-fold. A cluster analysis demonstrated that predictors of preterm birth in women with a high risk of pregnancy loss included: threatened pregnancy loss associated with chorionic/placental abruption, cervical incompetence, uterine fibroid growth to a large size, history of multiple spontaneous pregnancy losses, cervical tears during past labor, and gestational diabetes diagnosed for the first time during the current pregnancy.
Women with a high risk of pregnancy loss treated with Arabin's pessary or cerclage plus vaginal progesterone had a term delivery rate of 70.4% (169/240). The combined strategy of pregnancy management allowed to markedly reduce the number of preterm births.
确定妊娠丢失的风险因素和预测因素，并比较阿拉伯宫颈托与宫颈环扎术在妊娠丢失高风险妇女中的疗效。
这是一项在两个中心进行的回顾性病例对照研究，共纳入 240 例有早产高危因素的孕妇。I 组（n=161）包括在妊娠 14-24 周行阿拉伯宫颈托放置术的孕妇。II 组（n=79）包括在本次妊娠中行环形宫颈环扎术的孕妇。所有纳入研究的孕妇均接受 200mg/天的微粒化阴道孕酮治疗，直至妊娠 34 周。
I 组中 29.8%（48/161）的患者诊断为先兆性妊娠丢失，即孕早期出现点状出血或阴道流血，而 II 组中这一比例为 37.9%（=0.448）。I 组中有 8.1%（13/161）的孕妇产后出血，而 II 组中有 22.8%（=6.500；=0.011）。我们的研究表明，宫颈环扎术最适合有产科并发症史、宫颈长度<15mm 和大型子宫峡部肌瘤的患者。阿拉伯宫颈托的使用将早产率降低了 1.7 倍。聚类分析表明，妊娠丢失高风险妇女早产的预测因素包括：与绒毛膜/胎盘早剥、宫颈机能不全、子宫肌瘤生长至较大尺寸、多次自发性妊娠丢失史、既往分娩时宫颈撕裂、以及本次妊娠首次诊断为妊娠期糖尿病相关的威胁性妊娠丢失。
接受阿拉伯宫颈托或环扎术联合阴道孕酮治疗的妊娠丢失高风险妇女的足月分娩率为 70.4%（169/240）。妊娠管理的联合策略显著降低了早产的发生。
