Zhang Yuan, Wang Qingqing, Tan Zhangmin, Zhou Jin, Zhang Peizhen, Hou Hongying, Yin Yuzhu, Han Zhenyan
Department of Obstetrics and Gynecology, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
Front Surg. 2022 Jul 12;9:928322. doi: 10.3389/fsurg.2022.928322. eCollection 2022.
The purpose of this study was to investigate the role of amnioreduction in patients who underwent emergency cervical cerclage (ECC) with bulging membranes during the second trimester. This retrospective comparative study included 46 singleton pregnant women who had cervical dilation at least 1 cm with bulging membranes beyond the external cervical os and underwent ECC at the Third Affiliated Hospital of Sun Yat-sen University between December 2016 and December 2021. Cases were categorized as amnioreduction group ( = 16) and non-amnioreduction group ( = 30) according to whether amnioreduction was performed prior to ECC. The gestational age and cervical dilation at cerclage, operative time, prolongation of pregnancy, and outcomes of pregnancy were compared between the two groups. All 46 patients underwent successful ECC excepted one case with intraoperative rupture of membrane in non-amnioreduction group. In the amnioreduction group, the cervical dilation at cerclage was larger than that in the non-amnioreduction group (4.5 ± 2.2 vs. 2.2 ± 1.2 cm, < 0.001), and had more patients with cervical dilation ≥4 cm (50.0% vs. 10.0%, = 0.004). However, the gestational age at cerclage, operative time, prolongation of pregnancy, gestational age at delivery were not significantly different between the two groups (22.9 ± 2.8 vs. 22.9 ± 3.2 weeks, 31.1 ± 9.2 vs. 27.9 ± 11.4 min, 21.3 ± 21.5 vs. 38.7 ± 40.2 days, 25.9 ± 4.5 vs. 28.4 ± 6.1 weeks; > 0.05). The rates of delivery ≥28 weeks, ≥32 weeks, and live birth were 20.0% vs. 80.0%, 12.5% vs. 26.7%, 56.3% vs. 66.7% ( > 0.05) in amnioreduction group and non-amnioreduction group, respectively. In conclusion, even in cases with larger cervical dilation, the application of amnioreduction with ECC is possible to get the acceptable pregnancy outcomes. These findings suggested that amnioreduction may be a safe and feasible option to be applied before ECC, especially for those with advanced cervical dilation and bulging membranes.
本研究的目的是探讨羊水减量在孕中期胎膜膨出并接受紧急宫颈环扎术（ECC）患者中的作用。这项回顾性对照研究纳入了46名单胎孕妇，她们于2016年12月至2021年12月期间在中山大学附属第三医院就诊，宫颈扩张至少1厘米且胎膜膨出至宫颈外口以外，并接受了ECC。根据ECC前是否进行羊水减量，将病例分为羊水减量组（n = 16）和非羊水减量组（n = 30）。比较两组患者环扎时的孕周、宫颈扩张情况、手术时间、妊娠延长情况及妊娠结局。46例患者均成功接受了ECC，非羊水减量组有1例术中胎膜破裂。羊水减量组环扎时的宫颈扩张程度大于非羊水减量组（4.5±2.2 vs. 2.2±1.2厘米，P<0.001），且宫颈扩张≥4厘米的患者更多（50.0% vs. 10.0%，P = 0.004）。然而，两组患者环扎时的孕周、手术时间、妊娠延长时间、分娩时的孕周差异均无统计学意义（22.9±2.8 vs. 22.9±3.2周，31.1±9.2 vs. 27.9±11.4分钟，21.3±21.5 vs. 38.7±40.2天，25.9±4.5 vs. 28.4±6.1周；P>0.05）。羊水减量组和非羊水减量组孕周≥28周、≥32周的分娩率及活产率分别为20.0% vs. 80.0%、12.5% vs. 26.7%、56.3% vs. 66.7%（P>0.05）。总之，即使在宫颈扩张较大的情况下，ECC联合羊水减量应用也可能获得可接受的妊娠结局。这些结果表明，羊水减量可能是ECC前一种安全可行的选择，尤其是对于宫颈扩张进展且胎膜膨出的患者。
