双胎妊娠中的宫颈环扎术：一项更新的系统评价和荟萃分析。
Cervical cerclage in twin pregnancies: An updated systematic review and meta-analysis.
作者信息
Liu Yijun, Chen Meng, Cao Tiantian, Zeng Shuai, Chen Ruixin, Liu Xinghui
机构信息
West China Second Hospital, Sichuan University, Department of Gynecology and Obstetrics, Chengdu, 610041, China.
West China Second Hospital, Sichuan University, Department of Gynecology and Obstetrics, Chengdu, 610041, China; West China Second Hospital, Sichuan University, Key Laboratory of Obstetrics and Gynecologic and Pediatric Diseases and Birth Defects of Ministry of Education, Chengdu, 610041, China.
出版信息
Eur J Obstet Gynecol Reprod Biol. 2021 May;260:137-149. doi: 10.1016/j.ejogrb.2021.03.013. Epub 2021 Mar 20.
OBJECTIVE
Data on the prevention of preterm birth in twin pregnancies with cervical cerclage remain inconsistent. Thus, this study aimed to comprehensively evaluate the value of cervical cerclage as a treatment strategy to prevent preterm birth in twin pregnancies with regard to both maternal and neonatal outcomes.
STUDY DESIGN
In this systematic review and meta-analysis, the PubMed, Cochrane Library, Medline, EMBASE, and Web of Science databases were searched for relevant studies and trials from their inception up to December 2020. Outcomes were expressed as risk ratios and standardized mean differences in a meta-analysis model using STATA 15.0 software.
RESULTS
The search included 944 studies, 15 of which were eligible for inclusion, representing 726 patients treated with cervical cerclage and 8578 non-cerclage treatment controls. When the cervical length was <15 mm, the risk ratio of preterm birth at <37 weeks (0.77, p = 0.01), <34 weeks (0.58, p = 0.002), and <32 weeks (0.61, p = 0.024) of gestation in the cerclage group was significantly lower than that in the non-cerclage group.
CONCLUSION
For twin pregnancies with a cervical length <15 mm, cervical cerclage was associated with significant reduction in preterm birth.
目的
宫颈环扎术预防双胎妊娠早产的数据仍不一致。因此，本研究旨在综合评估宫颈环扎术作为预防双胎妊娠早产治疗策略在母婴结局方面的价值。
研究设计
在这项系统评价和荟萃分析中，检索了PubMed、Cochrane图书馆、Medline、EMBASE和Web of Science数据库，以查找从数据库建立至2020年12月的相关研究和试验。使用STATA 15.0软件，在荟萃分析模型中将结局表示为风险比和标准化均值差。
结果
检索纳入944项研究，其中15项符合纳入标准，涉及726例行宫颈环扎术治疗的患者和8578例未行环扎术的对照患者。当宫颈长度<15 mm时，环扎术组妊娠<37周（0.77，p = 0.01）、<34周（0.58，p = 0.002）和<32周（0.61，p = 0.024）早产的风险比显著低于未行环扎术组。
结论
对于宫颈长度<15 mm的双胎妊娠，宫颈环扎术可显著降低早产风险。
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