Icahn School of Medicine at Mount Sinai, New York, NY, USA.
Touro College of Osteopathic Medicine, New York, NY, USA.
J Matern Fetal Neonatal Med. 2022 Dec;35(25):5703-5708. doi: 10.1080/14767058.2021.1892061. Epub 2021 Feb 28.
To evaluate which parameters of a sonographic cervical length measurement are associated with preterm birth in women with ultrasound- or exam-indicated cerclage.
This was a retrospective cohort study of women with singleton pregnancies who underwent ultrasound- or exam-indicated Shirodkar cerclage by a single maternal-fetal medicine practice between 2011 and 2019. All patients underwent sonographic cervical length measurement 2-3 weeks after cerclage placement, and then every 2-4 weeks up to 32 weeks. The images from the first and second post-cerclage cervical lengths were reviewed. Total cervical length, upper cervical length (from the internal cervical os to the cerclage), and lower cervical length (from the cerclage to the external os) were measured. The primary outcome for this study was gestational age at delivery.
A total of 114 women with cerclage were included (85 (74.6%) ultrasound-indicated and 29 (25.4%) exam-indicated). The first and second total cervical lengths correlated with gestational age at delivery ( = 0.26, =.005; = 0.33, <.001, respectively), and the change from first to second was inversely correlated with gestational age at delivery ( = -0.20, =.032). The first and second upper cervical lengths also correlated with gestational age at delivery ( = 0.22, = .019; = 0.33, <.001, respectively), and the change from first to second upper cervical length was inversely correlated with gestational age at delivery (= -0.20, = 0.029). Neither the first nor the second lower cervical lengths were significantly associated with gestational age at delivery. On regression analysis, total cervical length and upper cervical length were not independently associated with gestational age at delivery ( = .108 and =.806, respectively, for the first scan; = .153 and =.166, respectively, for the second scan).
Postcerclage total cervical length and upper cervical length are both associated with gestational age at delivery and risk of preterm birth, but not independently. After ultrasound- or exam-indicated cerclage, sonographic monitoring of either the total cervical length or the upper cervical length might be predictive of gestational age at delivery and the risk of preterm birth.
评估超声或检查指征行 Shirodkar 宫颈环扎术的孕妇中，宫颈长度测量的哪些参数与早产相关。
这是一项回顾性队列研究，纳入了 2011 年至 2019 年期间在单家母胎医学实践中因超声或检查指征而行 Shirodkar 宫颈环扎术的单胎妊娠女性。所有患者在环扎后 2-3 周进行超声宫颈长度测量，之后每 2-4 周测量一次，直至 32 周。回顾宫颈环扎术后第一次和第二次的宫颈长度图像。测量总宫颈长度、宫颈上段（从宫颈内口至环扎处）和宫颈下段（从环扎处至宫颈外口）。本研究的主要结局为分娩时的孕龄。
共纳入 114 例行宫颈环扎术的女性（85 例行超声检查，29 例行体格检查）。第一次和第二次总宫颈长度与分娩时的孕龄相关（ = 0.26， = 0.005； = 0.33， < 0.001），第一次和第二次总宫颈长度的变化与分娩时的孕龄呈负相关（ = -0.20， = 0.032）。第一次和第二次宫颈上段长度也与分娩时的孕龄相关（ = 0.22， = 0.019； = 0.33， < 0.001），宫颈上段长度的第一次和第二次变化与分娩时的孕龄呈负相关（ = -0.20， = 0.029）。宫颈下段的第一次和第二次长度均与分娩时的孕龄无显著相关性。回归分析显示，第一次和第二次扫描时的总宫颈长度和宫颈上段长度均与分娩时的孕龄无独立相关性（第一次扫描时分别为 = 0.108 和 = 0.806；第二次扫描时分别为 = 0.153 和 = 0.166）。
宫颈环扎术后的总宫颈长度和宫颈上段长度均与分娩时的孕龄和早产风险相关，但无独立相关性。在超声或体格检查指征行宫颈环扎术后，监测总宫颈长度或宫颈上段长度可能有助于预测分娩时的孕龄和早产风险。
