高危妊娠患者经阴道宫颈环扎术（TVC）置扎与拆除的结局：单中心经验。
Outcomes following Placement and Removal of Transvaginal Cerclage in at Risk Pregnancies: A Single Center Experience.
机构信息
Department of Maternal-Fetal Medicine, Southern Illinois University School of Medicine, USA.
Department of Obstetrics and Gynecology, Southern Illinois University School of Medicine, USA.
出版信息
J Pregnancy. 2022 Jul 13;2022:4277451. doi: 10.1155/2022/4277451. eCollection 2022.
OBJECTIVE
The objective of this study was to estimate the time between removal of cerclage and delivery, stratified by indication for cerclage placement (elective or non-elective). Additionally, delivery within 72 hours after cerclage removal was compared between elective and non-elective cerclage placement, as well as between ultrasound-indicated and physical examination-indicated cerclage placement.
DESIGN
A single-center retrospective cohort study. , Clinical information of 72 pregnant women who underwent transvaginal cerclage over a 4-year period was obtained. Comparisons were made between elective (history-indicated) and non-elective (ultrasound or physical examination-indicated) cerclage placement. Comparisons were also made between physical examination-indicated and ultrasound-indicated cerclage.
RESULTS
Compared to those who had a non-elective cerclage, women undergoing elective cerclage were more likely to have history of cervical treatment (44% vs. 15%, = 0.02), and spontaneous preterm delivery (92% vs. 61%, = 0.003). There was no difference in the rate of delivery ≤72 hours following cerclage removal between women who had elective cerclage and those who had non-elective cerclage (46% vs. 58%, = 0.47). Women who had an elective cerclage were more likely to have elective cerclage removal ≥36 weeks (71.8% vs. 39.4%, = 0.01), compared to those who had undergone non-elective cerclage. The rate of delivery ≤72 hours following removal of cerclage was greater in women who had a physical examination-indicated cerclage compared to women who had ultrasound-indicated cerclage (80% vs. 39%, = 0.04). Among women who had an elective cerclage, there was no difference in the rate of delivery at ≤72 hours between those who had elective cerclage removal at 36 weeks compared to those electively removed at 37 weeks (31% vs. 58%, = 0.30). No complications such as fetal demise, iatrogenic amniotic membrane rupture, hemorrhage, or cervical laceration were reported within this cohort.
CONCLUSION
Cerclage indication should be considered prior to scheduling elective cerclage removal. Women who had an elective cerclage are most likely to get it electively removed at 36 weeks compared to their counterparts who had a non-elective cerclage. Furthermore, women who had a physical examination-indicated cerclage are most likely to deliver within 72 hours of cerclage removal.
目的
本研究旨在估计宫颈环扎拆除与分娩之间的时间间隔，并按宫颈环扎放置的适应证（选择性或非选择性）进行分层。此外，还比较了选择性和非选择性宫颈环扎放置、超声检查指征和体格检查指征与宫颈环扎拆除后 72 小时内分娩之间的关系。
设计
单中心回顾性队列研究。
方法
对 4 年内接受经阴道宫颈环扎术的 72 例孕妇的临床资料进行了回顾性研究。对选择性（病史指征）和非选择性（超声或体格检查指征）宫颈环扎放置进行了比较。还比较了体格检查指征与超声检查指征的宫颈环扎。
结果
与非选择性宫颈环扎相比，接受选择性宫颈环扎的患者更有可能有宫颈治疗史（44% vs. 15%， = 0.02）和自发性早产（92% vs. 61%， = 0.003）。选择性宫颈环扎和非选择性宫颈环扎后 72 小时内分娩的发生率无差异（46% vs. 58%， = 0.47）。与非选择性宫颈环扎相比，行选择性宫颈环扎的患者更有可能在≥36 周时行选择性宫颈环扎拆除（71.8% vs. 39.4%， = 0.01）。与超声检查指征相比，体格检查指征的患者更有可能在宫颈环扎拆除后 72 小时内分娩（80% vs. 39%， = 0.04）。在接受选择性宫颈环扎的患者中，选择性宫颈环扎拆除时间为 36 周与 37 周时，72 小时内分娩的发生率无差异（31% vs. 58%， = 0.30）。在本队列中，未报告胎儿死亡、医源性羊膜破裂、出血或宫颈裂伤等并发症。
结论
在安排选择性宫颈环扎拆除之前，应考虑宫颈环扎的适应证。与非选择性宫颈环扎相比，行选择性宫颈环扎的患者更有可能在 36 周时进行选择性宫颈环扎拆除。此外，体格检查指征的患者更有可能在宫颈环扎拆除后 72 小时内分娩。
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