Department of Obstetrics and Gynaecology, Nnamdi Azikiwe University, Teaching Hospital, Nnewi, Anambra State, Nigeria.
Department of Obstetrics and Gynaecology, Nnamdi Azikiwe University, Awka, Nigeria.
Biomed Res Int. 2023 Jan 9;2023:8782854. doi: 10.1155/2023/8782854. eCollection 2023.
Cervical cerclage is the procedure of choice for preventing preterm delivery due to cervical insufficiency. The indication for its application may be based on the woman's reproductive history, findings at ultrasound, or clinical findings on vaginal examination. Pregnancy outcomes from these indications are variable according to the available literature.
To compare the effectiveness and reproductive outcomes (miscarriage, preterm birth rates, and birth weights) of McDonald's cervical cerclage after history-indicated and ultrasound-indicated cervical cerclage in pregnant women.
The retrospective cohort study was conducted at Life International Hospital Awka, Nigeria and Life Specialist Hospital Nnewi, Nigeria. Pregnant women, who had a McDonald's cervical cerclage performed due to either history or ultrasound indication between January 1, 2011, and December 31, 2020, were included in the study. Women with multiple pregnancies and those with physical examination-indicated or emergency cerclages were excluded. The main outcome measures included the prevalence of cervical cerclage, miscarriage, and preterm delivery rates. Outcomes were compared between groups with the chi-square test, Fisher's exact test, or Student's test. value of < 0.5 was set as significant value.
Overall, during the study period, 5392 deliveries occurred in the study sites, of which 103 women had a history-indicated or ultrasound-indicated cervical cerclage. This resulted in a 1.91% prevalence rate for history-indicated and ultrasound-indicated cervical cerclage. Of these, 68 (66%) had history indicated, while 35 (34%) had ultrasound-indicated cerclage. There was no difference in the sociodemographic characteristics of both groups. Both groups had similar miscarriage rates: 1.18 in 1000 and 1.04 in 1000 deliveries, respectively (RR 1.160, 95% CI: 0.3824 to 3.5186, = 0.793). There was more preterm delivery in history-indicated cerclage than ultrasound-indicated cervical cerclage (26.50% vs. 17.10%; = 0.292), though the difference was not statistically significant. The ultrasound group had a higher average birthweight than the history group (2.67 ± 0.99 vs. 2.53 ± 0.74). However, this difference was not statistically significant.
The effectiveness and reproductive outcomes (miscarriage, preterm birth rates, and birth weights) of pregnant women with cervical cerclage due to history-indicated and ultrasound-indicated cervical cerclage appear similar. When needed, cervical cerclage should be freely applied for cervical insufficiency, irrespective of the type of indication.
宫颈环扎术是预防因宫颈功能不全导致早产的首选方法。其应用指征可能基于女性的生育史、超声检查结果或阴道检查的临床发现。根据现有文献，这些指征的妊娠结局各不相同。
比较因病史和超声指征行 McDonald 宫颈环扎术的孕妇的有效性和生殖结局（流产、早产率和出生体重）。
这项回顾性队列研究在尼日利亚阿夸的 Life International 医院和尼日利亚新威的 Life Specialist 医院进行。纳入 2011 年 1 月 1 日至 2020 年 12 月 31 日期间因病史或超声指征行 McDonald 宫颈环扎术的孕妇。排除多胎妊娠以及体格检查指征或紧急环扎的孕妇。主要结局指标包括宫颈环扎术的流行率、流产和早产率。使用卡方检验、Fisher 确切检验或学生 t 检验比较组间差异。设 值＜0.05 为差异有统计学意义。
在整个研究期间，研究地点共发生了 5392 次分娩，其中 103 名孕妇因病史或超声指征行宫颈环扎术，导致病史和超声指征宫颈环扎术的流行率分别为 1.91%和 1.91%。其中，68 例（66%）有病史指征，35 例（34%）有超声指征。两组的社会人口学特征无差异。两组的流产率相似：每 1000 例分别为 1.18 和 1.04（RR 1.160，95%CI：0.3824 至 3.5186， = 0.793）。病史指征的宫颈环扎术早产率高于超声指征的宫颈环扎术（26.50% vs. 17.10%； = 0.292），但差异无统计学意义。超声组的平均出生体重高于病史组（2.67 ± 0.99 与 2.53 ± 0.74），但差异无统计学意义。
因病史和超声指征行宫颈环扎术的孕妇的有效性和生殖结局（流产、早产率和出生体重）似乎相似。当需要时，应根据宫颈功能不全的类型自由应用宫颈环扎术。
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