Garry N, Keenan O, Lindow S W, Darcy T
Department Obstetrics and Gynaecology, Coombe Women & Infants University Hospital, Dublin, Ireland.
UCD Medical School, Dublin, Ireland.
Eur J Obstet Gynecol Reprod Biol. 2021 Jan;256:225-229. doi: 10.1016/j.ejogrb.2020.11.020. Epub 2020 Nov 11.
Local excisional treatment of neoplastic disease of the cervix in the form of loop excision (LLETZ) and conisation has been associated with adverse pregnancy outcomes including prelabour premature rupture of membranes (PPROM) and spontaneous preterm birth (SPTB). Insertion of a cervical cerclage is indicated for women with a short cervix <25 mm between 16 and 24 weeks gestation who also have a history of either PPROM or a history of cervical excisional treatment. The optimum timing of the cerclage and surgical technique used are both open to debate. This retrospective review of cases was performed to examine the outcomes of elective pre pregnancy placement of abdominal cervical cerclage in women who have undergone cervical excision surgery for neoplastic disease.
This was a retrospective review of case notes. Over a 10 year period 20 women who had previous cervical excision surgery had pre-pregnancy abdominal cerclage placed became pregnant with 26 pregnancies. One woman had a cone biopsy, 9 had a single LLETZ procedure, 8 had 2 LLETZ procedures and 2 women had 3 LLETZ procedures prior to the cerclage.
21 pregnancies were achieved spontaneously, 1 by intrauterine insemination (IUI) and 4 were conceived by in-vitro fertilisation (IVF). Overall, 22 of 26 (84.6 %) pregnancies were delivered at term. There was a single 7 week miscarriage and 3 premature deliveries (12 %) including 1 preterm birth at 29 + 4 weeks gestation after an antepartum haemorrhage (APH) and 2 late preterm births at 36 + 3 (following APH) and 36 + 4 weeks gestation following preterm labour. All 25 women were delivered by Caesarean section and all 25 babies survived.
There results of prophylactic minimally invasive insertion of a transabdominal cerclage in women with LLETZ treatments or cone biopsy prior to pregnancy demonstrated 84.6 % of pregnancies resulted in a live birth. The premature delivery rate was 12 %.
以环形电切术（LLETZ）和锥形切除术形式对宫颈肿瘤性疾病进行局部切除治疗，已与包括胎膜早破（PPROM）和自然早产（SPTB）在内的不良妊娠结局相关。对于妊娠16至24周宫颈短于25mm且有PPROM病史或宫颈切除治疗史的女性，建议行宫颈环扎术。环扎的最佳时机和所采用的手术技术均存在争议。本病例回顾旨在研究因肿瘤性疾病接受宫颈切除手术的女性择期孕前放置腹式宫颈环扎术的结局。
这是一项病例记录回顾性研究。在10年期间，20名曾接受宫颈切除手术的女性在孕前放置了腹式宫颈环扎术并怀孕26次。1名女性曾行锥形活检，9名女性曾行单次LLETZ手术，8名女性曾行2次LLETZ手术,2名女性在环扎术前曾行3次LLETZ手术。
21次妊娠自然受孕，1次通过宫内人工授精（IUI）受孕，4次通过体外受精（IVF）受孕。总体而言，26次妊娠中有22次（84.6%）足月分娩。有1次7周流产和3次早产（12%），包括1次妊娠29 + 4周产前出血（APH）后的早产以及2次妊娠36 + 3周（APH后）和36 + 4周早产临产的晚期早产。所有25名女性均行剖宫产分娩，所有25名婴儿均存活。
对孕前接受LLETZ治疗或锥形活检女性进行预防性微创经腹环扎术的结果显示，84.6%的妊娠分娩存活婴儿。早产率为12%。
