Bauer Alison M, Lappen Justin R, Hackney David N
Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, MetroHealth Medical Center, University Hospitals Cleveland Medical Center, Cleveland, Ohio.
Am J Perinatol. 2020 Jan;37(1):119-126. doi: 10.1055/s-0039-3401851. Epub 2020 Jan 6.
The placement of a cervical cerclage in early pregnancy could influence subsequent labor outcomes at term. Prior studies have yielded conflicting results regarding the potential association with adverse labor outcomes such as cesarean delivery (CD), cervical laceration, and prolonged labor. Our objective was to evaluate rate of CD and adverse maternal outcomes in women who labored at term with and without a cerclage within the Consortium on Safe Labor (CSL) cohort. We hypothesize that women with a cerclage in the incident pregnancy will have an increased frequency of CD and other adverse term labor outcomes.
A retrospective cohort study was performed using data from the CSL. Women with live nonanomalous singleton gestations≥ 37 weeks with induced or spontaneous labor were identified. The risk of CD and other maternal and neonatal outcomes were compared between women with and without cerclage placement during pregnancy. Univariable and multivariable analyses were performed with adjustment for confounding factors. Planned subgroup analysis by history of CD was performed.
A total of 374 of the 147,463 patients who met study inclusion criteria in the CSL (0.25%) had a cerclage. In univariable analysis, cerclage placement was associated with a significant increase in the frequency of CD (17.1 vs. 12.8%, = 0.016, odds ratio: 1.4, 95% CI: 1.07-1.84), cervical lacerations, infectious morbidity, and blood loss. The association with CD persisted in multivariable regression. Cerclage placement was not associated with an increased risk of neonatal morbidity.
Cerclage placement in pregnancy is associated with an increased risk of CD, cervical laceration, and infectious morbidity among women delivering at term. These findings suggest that cerclage placement may impact labor progression and outcomes. However, the magnitude of the association may not alter clinical decisions regarding cerclage placement in appropriate candidates.
孕早期放置宫颈环扎带可能会影响足月分娩结局。既往研究对于其与剖宫产（CD）、宫颈裂伤和产程延长等不良分娩结局之间的潜在关联得出了相互矛盾的结果。我们的目的是在安全分娩联盟（CSL）队列中评估足月分娩时有无宫颈环扎带的女性的剖宫产率及不良母体结局。我们假设妊娠期间放置宫颈环扎带的女性剖宫产及其他不良足月分娩结局的发生率会增加。
利用CSL的数据进行了一项回顾性队列研究。纳入妊娠≥37周、单胎、活产、非畸形且经引产或自然分娩的女性。比较妊娠期间有无宫颈环扎带的女性发生剖宫产及其他母体和新生儿结局的风险。进行了单变量和多变量分析，并对混杂因素进行了校正。根据剖宫产史进行了计划亚组分析。
CSL中符合研究纳入标准的147463例患者中，共有374例（0.25%）放置了宫颈环扎带。在单变量分析中，放置宫颈环扎带与剖宫产频率显著增加相关（17.1%对12.8%，P = 0.016，比值比：1.4，95%可信区间：1.07 - 1.84），还与宫颈裂伤、感染性疾病及失血相关。在多变量回归中，与剖宫产的关联依然存在。放置宫颈环扎带与新生儿发病风险增加无关。
妊娠期间放置宫颈环扎带与足月分娩女性的剖宫产、宫颈裂伤及感染性疾病风险增加相关。这些发现提示宫颈环扎带的放置可能会影响产程进展和结局。然而，这种关联的程度可能不会改变针对合适候选者放置宫颈环扎带的临床决策。
