Zhu Y C, Liu Y, Zhu S N, Liu Y N, Liu M H, Chen J, Yang H X
Department of Obstetrics and Gynecology, Peking University First Hospital, Beijing 100034, China.
Department of Medical Statistics, Peking University First Hospital, Beijing 100034, China.
Zhonghua Fu Chan Ke Za Zhi. 2021 Feb 25;56(2):89-95. doi: 10.3760/cma.j.cn112141-20200925-00740.
To investigate the clinical outcomes of different treatment options on singleton short cervix and its influence factors. Totally 435 cases of singleton pregnancies who were diagnosed with short cervix (≤25 mm) between 12 to 33 gestational weeks in Peking University First Hospital from January 2018 to December 2018 were enrolled, including 21 cases with cervical length <10 mm, 414 cases with cervical length between 10 to 25 mm. The onset time was <24 gestational weeks in 106 cases, while 104 cases were at 24-29 gestational weeks and 225 cases of ≥30 gestational weeks. Gestational outcomes including delivery before 37 weeks, delivery before 34 weeks, neonatal birth weight (NBW) and adverse neonatal outcome (ANO) were compared among three treatment groups: rest group, progesterone group and cerclage group. Influence factors were also investigated. (1) The incidence of short cervix in pregnancy was 7.07% (435/6 155), while 106 cases were at <24 gestational weeks (1.72%, 106/6 155), 104 cases (1.69%, 104/6 155) at 24-29 gestational weeks and 225 cases (3.66%, 225/6 155) at ≥30 gestational weeks. (2) In the group of cervical length <10 mm, rate of delivery before 37 and 34 weeks were 62% (13/21) and 57% (12/21) respectively. One case of progesterone treatment underwent miscarriage. Compared with rest group (=8), delivery weeks [28.5 (25.0-40.0) vs 37.0 (28.0-40.0), =0.020] and NBW [1 245 g (630-3 830 g) vs 2 648 g (1 560-3 830 g), =0.028] were higher in cerclage group (=9), while ANO was not statistically different (>0.05). (3) In the group of cervical length ≥10 mm before 24 gestational weeks, the delivery weeks, incidence of delivery before 34 weeks, adjusted incidence of delivery before 37 weeks, NBW and ANO were not statistically different (>0.05) among rest group (=36), progesterone group (=26) and cerclage group (=34). In vitro fertilization (=11.97, 95%: 1.88-76.44, =0.009), infection (=46.03, 95%: 5.12-413.58, =0.001), sludge on sonography (=9.87, 95%: 1.69-57.60, =0.011) and history of short cervix (=7.24, 95%: 1.04-50.24, =0.045) were independent risk factors of preterm birth. (4) In the group of cervical length ≥10 mm and gestational weeks between 24-29, the delivery weeks, incidence of delivery before 37 weeks, incidence of delivery before 34 weeks, NBW and ANO were not statistically different (>0.05) among rest group (=52), progesterone group (=34) and cerclage group (=9). Infection was an independent risk factor of preterm birth (=56.40, 95%: 4.67-680.61, =0.002). (5) Outcomes of 223 cases were relatively good in the group of cervical length ≥10 mm beyond 30 gestational weeks. The incidence of delivery before 34 weeks was 6.3% (14/223). The delivery weeks, incidence of delivery before 37 and 34 weeks, NBW and ANO were not statistically different (>0.05) among 3 groups. Infection (=10.91, 95%: 2.21-53.96, =0.003) and history of preterm birth (=8.63, 95%: 1.25-59.65, =0.029) were independent risk factors of preterm birth. Short cervix is a common complication of pregnancy. Cervical cerclage is related with better outcome for patients with cervical length <10 mm. Neither progesterone nor cervical cerclage improves pregnancy outcome for >10 mm cervical length patients comparing with rest. Infection, sludge, in vitro fertilization, history of short cervix and history of preterm birth are independent risk factors of preterm birth in short cervix pregnancies.
探讨不同治疗方案对单胎短宫颈的临床结局及其影响因素。选取2018年1月至2018年12月在北京大学第一医院就诊的单胎妊娠孕妇435例，这些孕妇在孕12至33周时被诊断为短宫颈（≤25 mm），其中宫颈长度<10 mm的有21例，宫颈长度在10至25 mm之间的有414例。发病孕周<24周的有106例，24至29周的有104例，≥30周的有225例。比较休息组、孕酮组和宫颈环扎组三个治疗组的妊娠结局，包括37周前分娩、34周前分娩、新生儿出生体重（NBW）和不良新生儿结局（ANO）。同时调查影响因素。（1）妊娠短宫颈的发生率为7.07%（435/6155），其中<24孕周的有106例（1.72%，106/6155），24至29孕周的有104例（1.69%，104/6155），≥30孕周的有225例（3.66%，225/6155）。（2）在宫颈长度<10 mm组，37周和34周前分娩率分别为62%（13/21）和57%（12/21）。1例接受孕酮治疗的孕妇发生流产。与休息组（n = 8）相比，宫颈环扎组（n = 9）的分娩孕周[28.5（25.0 - 40.0）对37.0（28.0 - 40.0），P = 0.020]和NBW[1245 g（630 - 3830 g）对2648 g（1560 - 3830 g），P = 0.028]更高，而ANO无统计学差异（P>0.05）。（3）在孕24周前宫颈长度≥10 mm组，休息组（n = 36）、孕酮组（n = 26）和宫颈环扎组（n = 34）之间的分娩孕周、34周前分娩发生率、调整后的37周前分娩发生率、NBW和ANO无统计学差异（P>0.05）。体外受精（P = 11.97，95%CI：1.88 - 76.44，P = 0.009）、感染（P = 46.03，95%CI：5.12 - 413.58，P = 0.001）、超声检查有积液（P = 9.87，95%CI：1.69 - 57.60，P = 0.011）和短宫颈病史（P = 7.24，95%CI：1.04 - 50.24，P = 0.045）是早产的独立危险因素。（4）在宫颈长度≥10 mm且孕周在24至29周组，休息组（n = 52）、孕酮组（n = 34）和宫颈环扎组（n = 9）之间的分娩孕周、37周前分娩发生率、34周前分娩发生率、NBW和ANO无统计学差异（P>0.05）。感染是早产的独立危险因素（P = 56.40，95%CI：4.67 - 680.61，P = 0.002）。（5）在孕周≥30周且宫颈长度≥10 mm组，223例患者结局相对较好。34周前分娩发生率为6.3%（14/223）。三组之间的分娩孕周、37周和34周前分娩发生率、NBW和ANO无统计学差异（P>0.05）。感染（P = 10.91，95%CI：2.21 - 53.96，P = 0.003）和早产史（P = 8.63，95%CI：1.25 - 59.65，P = 0.029）是早产的独立危险因素。短宫颈是妊娠常见并发症。宫颈环扎术对宫颈长度<10 mm的患者结局较好。与休息组相比,孕酮和宫颈环扎术均未改善宫颈长度>10 mm患者的妊娠结局。感染、积液、体外受精、短宫颈病史和早产史是短宫颈妊娠早产的独立危险因素。
