Department of Obstetrics and Gynecology, MacKay Memorial Hospital, No. 92, Section 2, Zhong-Shan North Road, Taipei, 10449, Taiwan.
Department of Medical Research, MacKay Memorial Hospital, Taipei, Taiwan.
BMC Pregnancy Childbirth. 2023 Oct 24;23(1):750. doi: 10.1186/s12884-023-06071-w.
We previously demonstrated that pregnant women with a history of cervical insufficiency had a softer anterior cervical lip, shorter cervical length and wider endocervical canal in the first trimester. The aim of this study was to investigate changes in cervical elastography, cervical length, and endocervical canal width in the second trimester after cerclage, and further discuss whether these ultrasound parameters are predictive of preterm delivery.
This was a secondary analysis of cervical changes in singleton pregnancies after cerclage from January 2016 to June 2018. Cervical elastography, cervical length, and endocervical canal width were measured during the second trimester in the cervical insufficiency group and control group without cervical insufficiency. Strain elastography under transvaginal ultrasound was used to assess cervical stiffness and presented as percentage (strain rate).
Among the 339 pregnant women enrolled, 24 had a history of cervical insufficiency and underwent cerclage. Both anterior and posterior cervical lips were significantly softer in the cervical insufficiency group even though they received cerclage (anterior strain rate: 0.18 ± 0.06% vs. 0.13 ± 0.04%; P = 0.001; posterior strain rate: 0.11 ± 0.03% vs. 0.09 ± 0.04%; P = 0.017). Cervical length was also shorter in the cervical insufficiency group (36.3 ± 3.6 mm vs. 38.3 ± 4.6 mm; P = 0.047). However, there was no significant difference in endocervical canal width between the two groups (5.4 ± 0.7 mm vs. 5.6 ± 0.7 mm; P = 0.159). Multivariate logistic regression analysis also revealed significant differences in anterior cervical lip strain rate (adjusted odds ratio [OR], 7.32, 95% confidence interval [CI], 1.70-31.41; P = 0.007), posterior cervical lip strain rate (adjusted OR, 5.22, 95% CI, 1.42-19.18; P = 0.013), and cervical length (adjusted OR, 3.17, 95% CI,1.08-9.29; P = 0.035). Among the four ultrasound parameters, softer anterior cervical lip (P = 0.024) and shorter cervical length (P < 0.001) were significantly related to preterm delivery.
Cervical cerclage can prevent widening of the endocervical canal, but not improve cervical elasticity or cervical length. Measuring anterior cervical elastography and cervical length may be valuable to predict preterm delivery.
我们之前的研究表明，有宫颈机能不全病史的孕妇在孕早期其宫颈前唇较软、宫颈管长度较短、宫颈内口较宽。本研究旨在探讨宫颈环扎术后宫颈弹性、宫颈管长度和宫颈内口宽度在孕中期的变化，并进一步探讨这些超声参数是否可预测早产。
这是 2016 年 1 月至 2018 年 6 月期间宫颈机能不全患者行宫颈环扎术后宫颈变化的二次分析。在宫颈机能不全组和无宫颈机能不全的对照组中，于孕中期测量宫颈弹性、宫颈管长度和宫颈内口宽度。经阴道超声下应变弹性成像用于评估宫颈硬度，以百分比（应变速率）表示。
在纳入的 339 名孕妇中，有 24 名有宫颈机能不全病史并接受了宫颈环扎术。即使接受了宫颈环扎术，宫颈前唇和后唇在宫颈机能不全组也明显变软（前唇应变速率：0.18±0.06%比 0.13±0.04%；P=0.001；后唇应变速率：0.11±0.03%比 0.09±0.04%；P=0.017）。宫颈机能不全组的宫颈管长度也较短（36.3±3.6mm 比 38.3±4.6mm；P=0.047）。然而，两组的宫颈内口宽度无显著差异（5.4±0.7mm 比 5.6±0.7mm；P=0.159）。多变量 logistic 回归分析还显示，宫颈前唇应变速率（调整优势比[OR]，7.32，95%置信区间[CI]，1.70-31.41；P=0.007）、宫颈后唇应变速率（调整 OR，5.22，95% CI，1.42-19.18；P=0.013）和宫颈长度（调整 OR，3.17，95% CI，1.08-9.29；P=0.035）差异有统计学意义。在这四个超声参数中，较软的宫颈前唇（P=0.024）和较短的宫颈长度（P<0.001）与早产显著相关。
宫颈环扎术可以防止宫颈内口变宽，但不能改善宫颈弹性或宫颈长度。测量宫颈前唇弹性成像和宫颈长度可能有助于预测早产。
