Demirel Cem, Goksever Celik Hale, Tulek Firat, Kucukdemir Bengisu, Gokalp Deniz, Ergin Tolga, Lembet Arda
Atasehir Memorial Hospital, IVF and Minimal Invasive Surgery Department, Istanbul, Turkey.
Health Sciences University Istanbul Kanuni Sultan Suleyman Training and Research Hospital, Department of Obstetrics and Gynecology, Istanbul, Turkey.
Eur J Obstet Gynecol Reprod Biol. 2021 Feb;257:59-63. doi: 10.1016/j.ejogrb.2020.12.012. Epub 2020 Dec 10.
OBJECTIVE(S): Cervical incompetence is an important cause of recurrent pregnancy loss, typically presenting in the second trimester with silent cervical dilation and premature delivery of the fetus. We aimed to evaluate the conception rate and time to conception or failure to conceive after preconceptional laparoscopic abdominal cerclage (LAC).
We conducted this retrospective observational cohort study at a tertiary referral center. Patients who underwent LAC in the nonpregnant state for a second-trimester pregnancy loss between June 2012 and February 2020 were included.
The subjects were 40 patients with a history of one or more second-trimester pregnancy losses despite the placement of vaginal cerclage, who had undergone LAC before contemplating a future pregnancy. The mean number of second-trimester pregnancy losses before LAC was two per woman. The ages of the women at the time of cerclage ranged from 21 to 42 years. The time to pregnancy, which was the primary outcome of the study, was determined as the number of menstrual cycles before the patient became pregnant after LAC and the number of cycles needed for the patient to achieve her latest pregnancy before LAC. Of the 40 women, 22.5 % were noted during the LAC operation to have a pelvic peritoneal pathology that might have affected fertility, and all such pathologies were treated concomitantly during the procedure. Spontaneous pregnancy rates before and after LAC were 96.4 % and 89.3 % (p = 0.299), and times to pregnancy before and after LAC were 6.3 ± 8.4 and 6.6 ± 8.1 cycles (p = 0.897). Neither difference was statistically significant. In more than 84 % of patients who became pregnant after LAC, pregnancy was sustained to the stage of viability.
CONCLUSION(S): In patients with cervical incompetence, LAC is a very effective intervention to sustain pregnancy to the stage of viability. If placed during the preconceptional period, it does not delay achieving pregnancy and does not have a negative impact on the chances of conception. This may be reassuring to women undergoing this procedure before they achieve a pregnancy.
宫颈机能不全是复发性流产的一个重要原因，通常在孕中期表现为宫颈无痛性扩张和胎儿早产。我们旨在评估孕前腹腔镜下腹部宫颈环扎术（LAC）后的受孕率以及受孕时间或未受孕情况。
我们在一家三级转诊中心进行了这项回顾性观察队列研究。纳入了2012年6月至2020年2月期间因孕中期流产在非孕状态下接受LAC的患者。
研究对象为40例患者，尽管已放置阴道宫颈环扎术，但仍有一次或多次孕中期流产史，她们在考虑未来怀孕前接受了LAC。LAC前每位女性孕中期流产的平均次数为两次。环扎时女性年龄在21至42岁之间。怀孕时间是该研究的主要结局，其定义为患者在LAC后怀孕前的月经周期数以及患者在LAC前达到最近一次怀孕所需的周期数。在40名女性中，22.5%在LAC手术期间被发现有盆腔腹膜病变，可能影响生育能力，所有这些病变在手术过程中均同时得到治疗。LAC前后的自然受孕率分别为96.4%和89.3%（p = 0.299），LAC前后的怀孕时间分别为6.3±8.4和6.6±8.1个周期（p = 0.897）。两者差异均无统计学意义。在LAC后怀孕的患者中，超过84%的患者怀孕持续到了存活阶段。
对于宫颈机能不全的患者，LAC是一种非常有效的干预措施，可使怀孕持续到存活阶段。如果在孕前进行，它不会延迟受孕，也不会对受孕几率产生负面影响。这可能会让接受该手术的女性在怀孕前感到安心。
