Department of Obstetrics and Gynecology, College of Medicine, The Catholic University of Korea, Seoul, Korea.
Department of Obstetrics and Gynecology, Dongguk University Ilsan Hospital, Goyang, Korea.
J Korean Med Sci. 2020 Mar 23;35(11):e66. doi: 10.3346/jkms.2020.35.e66.
This study aimed to evaluate the effect of cervical cerclage on the recurrence risk for preterm birth in singleton pregnant women after a twin spontaneous preterm birth (sPTB).
This multicenter retrospective cohort study included women who had a singleton pregnancy from January 2009 to December 2018 at 10 referral hospitals and a twin sPTB before the current pregnancy. We compared the cervical lengths during pregnancy and pregnancy outcomes, according to the placement of prophylactic or emergency cerclage. We evaluated the independent risk factors for sPTB (< 37 weeks of gestation) in a subsequent singleton pregnancy.
For the index singleton pregnancy, preterm birth occurred in seven (11.1%) of 63 women. There was no significant difference in the cervical lengths during pregnancy in women with and without cerclage. In a multivariate logistic regression analysis, the placement of emergency cerclage was an independent risk factor for subsequent singleton preterm birth (odds ratio [OR], 93.188; 95% confidence interval [CI], 1.633-5,316.628; = 0.027); however, the placement of prophylactic cerclage (OR, 19.264; 95% CI, 0.915-405.786; = 0.057) was not a factor. None of the women who received prophylactic cerclage delivered before 35 weeks' gestation in the index singleton pregnancy.
Cerclage did not lower the risk of preterm birth in a subsequent singleton pregnancy after a twin sPTB. However, emergency cerclage was an independent risk factor for preterm birth and there was no preterm birth before 35 weeks' gestation in the prophylactic cerclage group. Therefore, close monitoring of the cervical length and prophylactic cerclage might be considered in women who have experienced a twin sPTB at extreme gestation.
本研究旨在评估宫颈环扎术对既往双胎早产（sPTB）后单胎妊娠孕妇早产复发风险的影响。
本多中心回顾性队列研究纳入了 2009 年 1 月至 2018 年 12 月在 10 家转诊医院就诊的单胎妊娠孕妇，且其在本次妊娠前存在双胎 sPTB。我们比较了预防性或紧急宫颈环扎术孕妇的妊娠期间宫颈长度和妊娠结局。我们评估了后续单胎妊娠 sPTB（<37 孕周）的独立危险因素。
对于指数单胎妊娠，63 例孕妇中早产 7 例（11.1%）。有环扎和无环扎孕妇的妊娠期间宫颈长度无显著差异。多变量 logistic 回归分析显示，紧急环扎术的应用是后续单胎早产的独立危险因素（比值比[OR]，93.188；95%置信区间[CI]，1.633-5,316.628；P=0.027），而预防性环扎术（OR，19.264；95%CI，0.915-405.786；P=0.057）不是危险因素。在指数单胎妊娠中，预防性环扎术组无一例孕妇在 35 孕周前分娩。
宫颈环扎术不能降低既往双胎 sPTB 后后续单胎妊娠的早产风险。然而，紧急环扎术是早产的独立危险因素，预防性环扎术组无孕妇在 35 孕周前分娩。因此，对于经历过极早产双胎妊娠的女性，应考虑密切监测宫颈长度并预防性环扎术。
