Suff Natalie, Kunitsyna Maria, Shennan Andrew, Chandiramani Manju
Department of Women and Children's Health, King's College London, St Thomas' Hospital, London, SE1 7EH, United Kingdom.
Department of Women and Children's Health, King's College London, St Thomas' Hospital, London, SE1 7EH, United Kingdom.
Eur J Obstet Gynecol Reprod Biol. 2021 Apr;259:75-80. doi: 10.1016/j.ejogrb.2021.02.002. Epub 2021 Feb 6.
Preterm prelabour rupture of membranes occurs in over one third of pregnant women with a cervical cerclage in situ. In the setting of preterm prelabour rupture of membranes, clinicians are faced with the difficult decision of the optimal timing for removing the cerclage. We compared the maternal and neonatal outcomes following immediate removal or retention of the cervical cerclage.
Women were retrospectively identified from St Thomas's Hospital Preterm Surveillance clinic database. Asymptomatic women with preterm prelabour rupture of membranes were identified and separated into those that had the cerclage removed and those that had the cerclage retained within 24 h of presentation. Women who were symptomatic at presentation and who delivered within 24 h of presentation were excluded from the analysis. Maternal outcomes measured were latency between preterm prelabour rupture of membranes and delivery, gestation at delivery and maternal chorioamnionitis and infection markers. Neonatal outcomes including birthweight and Apgar scores were also measured.
43 women with cerclage retained for over 24 h following preterm prelabour rupture of membranes were compared to 25 women in whom the cerclage was removed. The latency between preterm prelabour rupture of membranes and delivery was on average 70.4 h longer in women who had their cerclage retained compared to the removed group (p = 0.009). Rates of chorioamnionitis, maternal blood results, neonatal birthweight and Apgar scores did not differ significantly between the two groups, however a trend towards higher rates of chorioamnionitis (60 % vs 45 %) were seen in the retained group.
Cervical cerclage retention in women following preterm prelabour rupture of membranes was associated with a longer latency period to delivery and was not significantly associated with any adverse obstetric, maternal or neonatal outcomes. Therefore, in women at risk of spontaneous preterm birth, cerclage retention may be beneficial, however these women and their babies should be monitored closely for any signs of infection. Further prospective randomised controlled studies assessing these outcomes as well as longer-term outcomes in these women and their children are needed.
超过三分之一接受宫颈环扎术的孕妇会发生未足月胎膜早破。在未足月胎膜早破的情况下，临床医生面临着拆除宫颈环扎带的最佳时机这一艰难抉择。我们比较了立即拆除或保留宫颈环扎带后的母婴结局。
从圣托马斯医院早产监测诊所数据库中回顾性识别出研究对象。识别出无症状的未足月胎膜早破女性，并将其分为在就诊后24小时内拆除环扎带的女性和保留环扎带的女性。就诊时有症状且在就诊后24小时内分娩的女性被排除在分析之外。测量的母本结局包括未足月胎膜早破至分娩的间隔时间、分娩时的孕周、母本绒毛膜羊膜炎及感染指标。还测量了包括出生体重和阿氏评分在内的新生儿结局。
将43例未足月胎膜早破后宫颈环扎带保留超过24小时的女性与25例拆除环扎带的女性进行比较。与拆除组相比，保留宫颈环扎带的女性未足月胎膜早破至分娩的平均间隔时间长70.4小时（p = 0.009）。两组间绒毛膜羊膜炎发生率、母本血液检查结果、新生儿出生体重和阿氏评分无显著差异，但保留组绒毛膜羊膜炎发生率有升高趋势（60%对45%）。
未足月胎膜早破女性保留宫颈环扎带与分娩间隔时间延长有关，与任何不良产科、母本或新生儿结局无显著关联。因此，对于有自发早产风险的女性，保留环扎带可能有益，然而这些女性及其婴儿应密切监测有无感染迹象。需要进一步开展前瞻性随机对照研究，评估这些结局以及这些女性及其子女的长期结局。
