Center of Reproductive Medicine, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, 3# Qingchun East Road, Hangzhou, 310016, People's Republic of China.
Key Laboratory of Reproductive Dysfunction Management of Zhejiang Province, 3# Qingchun East Road, Hangzhou, 310016, People's Republic of China.
Arch Gynecol Obstet. 2021 May;303(5):1197-1205. doi: 10.1007/s00404-020-05852-4. Epub 2021 Jan 2.
To compare the pregnancy outcome of emergency cerclage performed in twin and singleton pregnancies.
A retrospective trial was carried out in the Department of Obstetrics and Gynecology, Sir Run Run Shaw Hospital in Zhejiang, China, from January 2013 to December 2018. A total of 89 women with acute cervical incompetence underwent the emergency cerclage. Main outcome measures were gestational age at delivery and the fetal outcome.
There were 31 twin and 58 singleton pregnancies that underwent emergency cerclage. In singleton pregnancies, gestational age at delivery (31.57 ± 6.11 vs 28.81 ± 4.34, p = 0.016), and prolongation of pregnancy (8.69 ± 6.13 vs 5.41 ± 3.72, p < 0.001) were greater, and the preterm delivery rate before 34 weeks was lower (53.4% vs 80.6%, p = 0.011) compared with twin pregnancies. Fetal weight was greater in singletons than in twins (2377.3 ± 862.1 vs 1630.3 ± 557.6, p < 0.001), but the fetal survival rate was similar. The proportion of twin gestations was significantly higher in the group with preterm delivery before 34 weeks (44.6% vs 18.2%, p = 0.011) and the proportion of previous term delivery was higher in the group with delivery at or after 34 weeks (30.3% vs 12.5%, p = 0.039). The group with preterm delivery before 34 weeks had a significantly larger size of visible membranes at cerclage than the group with delivery at or after 34 weeks (2.23 ± 0.86 vs 1.64 ± 0.80, p = 0.001). In binary logistic regression analysis, twin gestations and a larger size of visible membranes were associated with an increased risk of preterm delivery.
The pregnancy outcome of emergency cerclage appears to have a better prognosis in singleton pregnancies than in twin pregnancies, and twin pregnancy is a risk factor for preterm delivery.
比较双胎妊娠与单胎妊娠行紧急宫颈环扎术的妊娠结局。
本研究为回顾性队列研究，于 2013 年 1 月至 2018 年 12 月在浙江大学医学院附属邵逸夫医院妇产科进行，共纳入 89 例急性宫颈机能不全行紧急宫颈环扎术的孕妇。主要结局指标为分娩时的孕龄和胎儿结局。
在单胎妊娠中，分娩时的孕龄（31.57±6.11 周 vs. 28.81±4.34 周，p=0.016）和延长妊娠时间（8.69±6.13 周 vs. 5.41±3.72 周，p<0.001）更大，而 34 周前早产率（53.4% vs. 80.6%，p=0.011）更低。单胎妊娠胎儿体重大于双胎妊娠（2377.3±862.1 g vs. 1630.3±557.6 g，p<0.001），但胎儿存活率相似。在 34 周前早产组中，双胎妊娠的比例明显更高（44.6% vs. 18.2%，p=0.011），而在 34 周及以后分娩组中，足月产的比例更高（30.3% vs. 12.5%，p=0.039）。在 34 周前早产组中，宫颈环扎时可见胎膜大小明显大于 34 周及以后分娩组（2.23±0.86 cm vs. 1.64±0.80 cm，p=0.001）。二元逻辑回归分析显示，双胎妊娠和可见胎膜较大是早产的危险因素。
紧急宫颈环扎术在单胎妊娠中的妊娠结局似乎优于双胎妊娠，而双胎妊娠是早产的危险因素。
