Department of Women and Children's Health, School of Life Course and Population Sciences, King's College London, London, UK.
UK TAC Support, Margate, UK.
BMC Pregnancy Childbirth. 2023 Oct 24;23(1):751. doi: 10.1186/s12884-023-06001-w.
Transabdominal cerclage (TAC) is a relatively uncommon intervention for preventing preterm birth. This study aimed to investigate the experience of women who had undergone this procedure.
The survey was designed in collaboration with a preterm birth studies public and patient involvement (PPI) group and ethical approval was granted by KCL BDM Research Ethics Panel (LRS-19/20-13205). Members of closed Facebook group, UK TAC Support, were invited to complete an online questionnaire about their experience of TAC, and pregnancies before and after having it placed. The survey was open between December 2019 and May 2020. Open and closed questions provided both qualitative and quantitative data for analysis, which was carried out using NVivo Pro 2020 v.1.4.1 qualitative data management software and SPSS Statistics 27 (IBM).
One hundred eighty-three participants completed the survey, having had TAC procedures carried out in 36 hospitals. Altogether, participants had experienced 287 preterm births (PTB) and late miscarriages (LM), equating to an average of 1.6 each (range 0-5), including 18 stillbirths. TAC was indicated in 123 (67%) for previous PTB and/or LM, 29 (16%) for cervical surgery and 31 (17%) for both. 151 (83%) TAC procedures were open, 32 (17%) laparoscopic. 86% (n = 157) were placed outside pregnancy. Of those placed in pregnancy, gestation at TAC ranged from 7 to 16 weeks. When comparing earliest pre- and post-TAC pregnancy gestation (excluding first trimester losses), median gestational weeks gained following TAC was 15.5 weeks (SD 6.89). Qualitative themes included: the struggle to get treatment; lack of TAC knowledge amongst clinicians; gratitude, hope and feeling protected; possible detrimental effects of TAC.
This very high-risk group found having a TAC gave great reassurance and hope, and were very grateful to have found the care they needed. However, they often struggled to get this support, frequently due to lack of clinician awareness. This may improve following roll-out of NHS England's Saving Babies Live Care Bundle and NHS commissioning guidelines for care of women at risk of PTB.
经腹宫颈环扎术（TAC）是一种预防早产的相对少见的干预措施。本研究旨在调查接受该手术的女性的经验。
该调查由早产研究公众和患者参与（PPI）小组合作设计，并获得 KCL BDM 研究伦理小组（LRS-19/20-13205）的伦理批准。封闭式 Facebook 群组 UK TAC Support 的成员被邀请完成一份关于 TAC 经历以及接受 TAC 前后妊娠的在线问卷。调查于 2019 年 12 月至 2020 年 5 月期间开放。开放式和封闭式问题为分析提供了定性和定量数据，使用 NVivo Pro 2020 v.1.4.1 定性数据管理软件和 SPSS Statistics 27（IBM）进行分析。
183 名参与者完成了调查，他们在 36 家医院接受了 TAC 手术。总的来说，参与者经历了 287 次早产（PTB）和晚期流产（LM），平均每人经历了 1.6 次（范围 0-5），包括 18 例死产。123 例（67%）因既往 PTB 和/或 LM 而进行 TAC，29 例（16%）因宫颈手术而进行 TAC，31 例（17%）因两者兼有而进行 TAC。151 例（83%）TAC 手术为开放式，32 例（17%）为腹腔镜式。86%（n=157）TAC 手术在妊娠前进行。在妊娠中进行 TAC 的病例中，TAC 的妊娠周数范围为 7 至 16 周。比较 TAC 前和 TAC 后最早的妊娠周数（不包括早期妊娠丢失），TAC 后获得的中位妊娠周数为 15.5 周（SD 6.89）。定性主题包括：争取治疗的斗争；临床医生对 TAC 的知识缺乏；感激、希望和受到保护的感觉；TAC 可能产生的不利影响。
这个高风险群体发现进行 TAC 会带来极大的安慰和希望，并且非常感激能够获得所需的护理。然而，他们通常很难获得这种支持，这主要是由于临床医生缺乏意识。在英国国民保健署推出“拯救婴儿生命护理包”和国家卫生服务委员会发布针对早产风险妇女护理指南后，这种情况可能会有所改善。
