Department of Obstetrics and Gynecology, Affiliated Maternity and Child Health Care Hospital of Nantong University, Nantong, 226007, China.
Department of Obstetrics and Gynecology, Shandong Provincial Maternal and Child Health Care Hospital Affiliated to Qingdao University, No. 238 Jingshi East Road, Jinan, 250014, China.
BMC Pregnancy Childbirth. 2023 Sep 7;23(1):645. doi: 10.1186/s12884-023-05974-y.
The study aims were to analyze pregnancy outcomes after the use of emergency cerclage in patients with different BMIs.
A total of 76 singleton pregnant patients who underwent emergency cerclage at a tertiary comprehensive hospital in China between Jan 2017 and Dec 2021 were retrospectively divided into an obesity group of 37 patients with BMIs ≥ 28 kg/m and a non-obesity group of 39 patients with BMIs < 28 kg/m. The medical records of patients were reviewed and all relevant clinical data were further collected into an itemized data spreadsheet for various analyses.
Emergent cerclage, along with amnioreduction if needed, could be safely performed on both obese and non-obese pregnant women with a dilated external cervix (> 1 cm), which effectively prolonged the gestational week up to ≥ 25 weeks. Obese gravidae had shorter suture-to-delivery intervals and mean pregnancy lengths but more spontaneous preterm births before 37 weeks, and a lower live birth rate (P < 0.05). Logistic regression analysis revealed that BMI, how many times cerclages have been performed during pregnancy (frequency of cerclage) and bacterial vaginosis, aerobic vaginitis and vulvovaginal candidiasis (vaginal microecology) were significantly correlated with fetal loss (P < 0.05), while rank correlation analysis established a negative correlation between BMI values and the suture-to-delivery interval (P = 0.031).
Pregnant cervical insufficiency patients with BMIs > 28 kg/m may ill-serve the gestational outcomes and suture-to-delivery interval after their emergent cerclage. Additionally, BMI, frequency of cerclage and vaginal microecology accounted for higher fetal loss in patients who underwent emergency cerclage.
本研究旨在分析不同 BMI 患者接受紧急宫颈环扎术（cerclage）后的妊娠结局。
回顾性分析 2017 年 1 月至 2021 年 12 月在中国一家三级综合医院接受紧急宫颈环扎术的 76 例单胎妊娠患者的临床资料，根据 BMI 将患者分为肥胖组（BMI≥28kg/m2，37 例）和非肥胖组（BMI<28kg/m2，39 例）。分析患者的病历资料，并将所有相关临床数据进一步收集到逐项数据电子表格中进行分析。
对于宫颈外口扩张（>1cm）的肥胖和非肥胖孕妇，紧急宫颈环扎术联合必要时的羊水减量可安全进行，有效地将孕周延长至≥25 周。肥胖孕妇的缝合至分娩间隔和平均妊娠时间更短，但在 37 周前自发性早产更多，活产率较低（P<0.05）。Logistic 回归分析显示，BMI、孕期宫颈环扎术的次数（环扎术频率）、细菌性阴道病、需氧性阴道炎和外阴阴道假丝酵母菌病（阴道微生态）与胎儿丢失显著相关（P<0.05），秩相关分析显示 BMI 值与缝合至分娩间隔呈负相关（P=0.031）。
BMI≥28kg/m2 的宫颈机能不全孕妇接受紧急宫颈环扎术后，妊娠结局和缝合至分娩间隔可能不佳。此外，BMI、环扎术频率和阴道微生态是接受紧急宫颈环扎术患者胎儿丢失的主要原因。
