中孕期或宫颈扩张晚期行羊水减量术联合紧急宫颈环扎术。
Amnioreduction with rescue cerclage at advanced cervical dilation or gestational age.
机构信息
Department of Obstetrics and Gynaecology, University of Toronto, Toronto, Ontario, Canada.
Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
出版信息
J Matern Fetal Neonatal Med. 2022 Dec;35(25):5607-5610. doi: 10.1080/14767058.2021.1888287. Epub 2021 Feb 21.
OBJECTIVE
To determine the feasibility of rescue cerclage and amnioreduction at advanced cervical dilation or gestational age.
METHODS
We present a retrospective case series of women who underwent rescue cerclage at either an advanced gestational age (24 + 0 to 24 + 6 weeks) or cervical dilation (≥4 cm), with a subset undergoing amnioreduction prior to cerclage placement.
RESULTS
Nine women were included and amnioreduction was performed in 7 (78%). A bi-modal distribution of obstetric outcomes was observed, with 5 (56%) women delivering ≥34 weeks gestation, 3 (33%) of which delivered at term. Two (22%) women experienced intra-operative rupture of membranes and subsequent perinatal deaths. Two (22%) women delivered extremely premature, with one resulting in infant death.
DISCUSSION
Our data show that rescue cerclage with amnioreduction may be successful at advanced gestational ages or cervical dilations, suggesting that these women should be included in prospective studies to better establish the efficacy and safety of this procedure.
目的
确定在宫颈扩张晚期或妊娠晚期行紧急宫颈环扎术和羊水减量术的可行性。
方法
我们回顾性分析了一组在妊娠晚期（24+0 至 24+6 周）或宫颈扩张（≥4cm）时行紧急宫颈环扎术的患者，其中一部分患者在环扎术前先行羊水减量术。
结果
共纳入 9 例患者，其中 7 例（78%）进行了羊水减量术。观察到产科结局呈双峰分布，5 例（56%）患者分娩孕周≥34 周，其中 3 例（33%）为足月分娩。2 例（22%）患者术中发生胎膜破裂，随后发生围产儿死亡。2 例（22%）患者分娩极早产儿，其中 1 例导致婴儿死亡。
讨论
我们的数据表明，在妊娠晚期或宫颈扩张时行紧急宫颈环扎术联合羊水减量术可能是成功的，这表明应将这些患者纳入前瞻性研究中，以更好地确定该手术的疗效和安全性。
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