Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
Department of Obstetrics and Gynecology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, South Korea.
Taiwan J Obstet Gynecol. 2021 Jul;60(4):665-673. doi: 10.1016/j.tjog.2021.05.014.
Cerclage operation is one of the most common obstetric controversies. The aim of this study was to compare the perinatal outcomes and placental inflammation of cerclage performed adherent and non-adherent to international guidelines.
This study included all consecutive women with singleton deliveries who underwent cerclage. According to the current American College of Obstetricians and Gynecologists (ACOG) guideline, we designated our study population into two groups: the adherent-to-guideline and non-adherent groups. Each group was categorized into two groups according to cervical length (CL) at the time of cerclage (<2.0 cm vs. ≥2.0 cm). We evaluated the reasons for cerclage, maternal characteristics, perioperative variables, pregnancy and neonatal outcomes, and placental inflammatory pathology according to the criteria proposed by the Society of Pediatric Pathology.
Among 310 women with cerclage, we excluded patients (n = 21) with indicated preterm delivery (PTD), major fetal anomaly, fetal death in-utero, and missing information for reason of cerclage. We also excluded patients who underwent physical examination-indicated cerclage (n = 53) and with missing information of CL at the time of cerclage (n = 52). A total of 184 women were eventually analyzed. In women with CL < 2.0 cm, the non-adherent group showed similar PTD (<28 weeks, <34 weeks) and neonatal composite morbidity rates compared to the adherent-to-guideline group. However, in women with CL ≥ 2.0 cm, the non-adherent group manifested significantly higher PTD (<28 weeks; 16.7% vs. 4.4%, p = 0.04, <34 weeks; 23.8% vs. 5.8%, p = 0.006) and neonatal composite morbidity (20.5% vs. 5.9%, p = 0.028) rates than the adherent-to-guideline group despite similar perioperative variables and lower PTD history rates. The non-adherent group with CL ≥ 2 cm at the time of cerclage was also associated with severe histologic chorioamnionitis (p = 0.033).
Cerclage performed beyond the current guidelines in pregnant women with CL ≥ 2.0 cm may confer an additional risk of perinatal complications in association with severe placental inflammation.
环扎术是最常见的产科争议之一。本研究旨在比较符合和不符合国际指南的环扎术的围产期结局和胎盘炎症。
本研究纳入了所有接受环扎术的单胎分娩的连续孕妇。根据美国妇产科医师学会（ACOG）的现行指南，我们将研究人群分为两组：符合指南组和不符合指南组。根据环扎时的宫颈长度（CL），每组又分为两组（<2.0cm 与≥2.0cm）。我们根据儿科病理学会提出的标准评估环扎的原因、产妇特征、围手术期变量、妊娠和新生儿结局以及胎盘炎症病理。
在 310 名接受环扎术的女性中，我们排除了因早产（PTD）指征、主要胎儿异常、胎儿宫内死亡和环扎术指征缺失而接受环扎术的患者（n=21），也排除了因体检指征而接受环扎术的患者（n=53）和环扎时 CL 信息缺失的患者（n=52）。最终共分析了 184 名女性。在 CL<2.0cm 的女性中，不符合指南组与符合指南组的 PTD（<28 周，<34 周）和新生儿复合发病率相似。然而，在 CL≥2.0cm 的女性中，不符合指南组的 PTD（<28 周：16.7% vs. 4.4%，p=0.04；<34 周：23.8% vs. 5.8%，p=0.006）和新生儿复合发病率（20.5% vs. 5.9%，p=0.028）明显高于符合指南组，尽管两组围手术期变量相似且 PTD 病史率较低。在环扎时 CL≥2cm 的不符合指南组也与严重的组织学绒毛膜羊膜炎相关（p=0.033）。
在 CL≥2.0cm 的孕妇中进行超出当前指南的环扎术可能会增加围产期并发症的风险，并与严重的胎盘炎症相关。
