Kobayashi Ami, Takahashi Hironori, Matsubara Shigeki, Baba Yosuke, Nagayama Shiho, Ogoyama Manabu, Horie Kenji, Suzuki Hirotada, Usui Rie, Ohkuchi Akihide, Fujiwara Hiroyuki
Department of Obstetrics and Gynecology, Jichi Medical University, 3311-1 Shimotsuke, Tochigi 329-0498, Japan.
Obstet Gynecol Int. 2021 Dec 26;2021:4351783. doi: 10.1155/2021/4351783. eCollection 2021.
The aims of this study were to clarify the following: (1) how often does prolonged pregnancy ≥34 weeks occur in patients with emergent cerclage without progesterone and (2) the risk factors preventing such pregnancy continuation.
This retrospective observational study was performed using medical records of patients for whom emergent cerclage had been performed between April 2006 and December 2018 in our institute.
Emergent cerclage was performed in 123 patients (median age: 34, interquartile range: 31-36). Primiparous patients numbered 44 (36%). A history of spontaneous preterm birth (SPTB) was present in 30 (24%). The median presurgical cervical length (CL) was 16 (8-21) mm at surgery. Of the 123, 20 (16%) were delivered at 33 + 6 weeks or less (<34 weeks). We conducted logistic regression analysis of the risk factors of SPTBs <34 weeks after cerclage. Three risk factors were identified that increased the risk of SPTB <34 weeks: presurgical CL 0 mm (odds ratio (OR): 5.30; 95% confidence interval (CI): 1.58-17.7), a history of SPTB (OR: 4.65; 95% CI: 1.38-15.7), and the presence of sludge (OR: 4.14; 95% CI: 1.20-14.3).
Three risk factors predicted SPTB <34 weeks after emergency cerclage without progesterone administration: unmeasurable CL (CL 0 mm), a history of SPTB, and the presence of sludge on ultrasound. SPTB <34 weeks occurred after emergency cerclage in 16% of patients, being comparable with the recent data with progesterone.
本研究旨在阐明以下问题：（1）在未使用孕激素的紧急宫颈环扎术患者中，孕周≥34周的过期妊娠发生率如何；（2）阻止此类妊娠继续的危险因素。
本回顾性观察性研究使用了2006年4月至2018年12月在我院接受紧急宫颈环扎术患者的病历。
123例患者接受了紧急宫颈环扎术（中位年龄：34岁，四分位间距：31 - 36岁）。初产妇44例（36%）。30例（24%）有自发性早产史。手术前宫颈长度（CL）的中位数在手术时为16（8 - 21）mm。123例患者中，20例（16%）在33⁺⁶周或更早（<34周）分娩。我们对环扎术后<34周自发性早产的危险因素进行了逻辑回归分析。确定了三个增加<34周自发性早产风险的危险因素：术前CL为0 mm（比值比（OR）：5.30；95%置信区间（CI）：1.58 - 17.7）、自发性早产史（OR：4.65；95% CI：1.38 - 15.7）以及存在宫腔积液（OR：4.14；95% CI：1.20 - 14.3）。
三个危险因素可预测在未使用孕激素的紧急宫颈环扎术后<34周的自发性早产：无法测量的CL（CL为0 mm）、自发性早产史以及超声检查显示存在宫腔积液。16%的患者在紧急宫颈环扎术后发生了<34周的自发性早产，这与近期使用孕激素的数据相当。
