Medical School, King's College London, London, UK.
Department of Women and Children's Health, King's College London, London, UK.
Acta Obstet Gynecol Scand. 2020 Nov;99(11):1486-1491. doi: 10.1111/aogs.13972. Epub 2020 Sep 2.
Emergency cesarean sections (EMCS) are associated with subsequent preterm birth, particularly at full dilation (FDCS), which is a cause of both second trimester miscarriages and early, recurrent spontaneous preterm birth (sPTB). The optimal management for these women in subsequent pregnancies is currently unknown. This study aims to assess efficacy of transvaginal cervical cerclage (TVC) in prevention of preterm birth among women who have had an EMCS followed by a subsequent late miscarriage or sPTB.
A historical cohort study was performed assessing outcomes of women attending the Preterm Surveillance Clinic at St Thomas' Hospital, London, who received TVC, with a history of EMCS (pregnancy A) followed by a sPTB/late miscarriage (pregnancy B) and a subsequent pregnancy (pregnancy C). A historical reference group managed in the same clinic was identified comprising women with any risk factor for sPTB, who required TVC. Incidence of delivery >24 to <30 weeks' gestation was compared with relative risk and 95% confidence intervals (CI). Subgroup analysis was carried out assessing women who had a previous FDCS.
209 women with a previous EMCS during labor (50 with FDCS), followed by sPTB/late miscarriage were identified. 178 progressed beyond 24 weeks; of these, 56 received TVC and formed the study group. 905 high-risk women were identified; of these, 154 received TVC and formed the reference group. Despite TVC treatment, 17/56 (30%) of the study group delivered <30 weeks' gestation compared with 5/154 (3%) of the reference group (RR 9.4, 95% CI 3.6-24.2, P < .001). In the subset of 17 women in the study group with a previous FDCS, followed by sPTB/late miscarriage, 6/17 (35%) delivered <30 weeks' gestation, significantly higher than the reference group (P < .001) but similar to EMCS at less than full dilation (35% vs 28%, P = .596). Overall, 33/72 (46%) women receiving cerclage with prior EMCS had either a mid-trimester loss or delivery <30 weeks.
Transvaginal cervical cerclage appears less effective in preventing preterm birth among pregnant women who have had an EMCS followed by a sPTB/late miscarriage compared with other high-risk women. The lack of efficacy in the subgroup with an FDCS was similar.
急诊剖宫产（EMCS）与随后的早产有关，尤其是在完全扩张时（FDCS），这是中期流产和早期、复发性自发性早产（sPTB）的原因。目前尚不清楚这些女性在随后的妊娠中的最佳治疗方法。本研究旨在评估经阴道宫颈环扎术（TVC）在预防先前有 EMCS 后发生晚期流产或 sPTB 的女性早产中的疗效。
对在伦敦圣托马斯医院早产监测诊所就诊的接受 TVC 治疗的妇女进行了一项历史队列研究，这些妇女有 EMCS （妊娠 A）的病史，随后发生 sPTB/晚期流产（妊娠 B）和随后的妊娠（妊娠 C）。确定了一个在同一诊所接受治疗的历史参考组，该组包括有 sPTB 风险因素且需要 TVC 的妇女。比较了分娩>24 至<30 周的发生率与相对风险和 95%置信区间（CI）。进行了亚组分析，评估了先前有 FDCS 的妇女。
确定了 209 名在分娩过程中进行过 EMCS（50 名进行过 FDCS）并随后发生 sPTB/晚期流产的妇女。178 名妇女超过 24 周；其中 56 名接受 TVC 治疗并组成研究组。确定了 905 名高危妇女；其中 154 名接受 TVC 治疗并组成参考组。尽管进行了 TVC 治疗，但研究组中有 17/56（30%）的妇女在<30 周时分娩，而参考组中有 5/154（3%）（RR 9.4，95%CI 3.6-24.2，P <.001）。在研究组中有 17 名妇女中，她们有先前的 FDCS，随后发生 sPTB/晚期流产，其中 6/17（35%）在<30 周时分娩，显著高于参考组（P <.001），但与未完全扩张的 EMCS 相似（35%比 28%，P =.596）。总的来说，在有先前 EMCS 的 72 名接受环扎术的妇女中，有 33/72（46%）的妇女中期流产或<30 周时分娩。
与其他高危妇女相比，经阴道宫颈环扎术在预防先前有 EMCS 后发生 sPTB/晚期流产的孕妇早产方面的效果似乎较差。在有 FDCS 的亚组中，效果不明显。
