Department of Obstetrics and Gynecology, The First Affiliated Hospital of Guangxi Medical University, Shuangyong Road, Nanning, Guangxi, 530021, China.
Guangxi Medical University, Shuangyong Road, Nanning, Guangxi, 530021, China.
BMC Pregnancy Childbirth. 2023 Nov 25;23(1):819. doi: 10.1186/s12884-023-06141-z.
This study aimed to assess the effectiveness of Mersilene tape versus alternative suture types in prolonging singleton pregnancies as well as other pregnancy and neonatal outcomes, in cases of history-, ultrasound-, and exam-indicated cervical cerclage.
A systematic review was conducted to identify relevant studies comparing different suture types in cervical cerclage procedures. The primary outcome of interest was preterm birth (PTB) rate < 37, <35, < 28, and < 24 weeks. Statistical analyses were performed to determine the relationship between suture type and various outcomes.
A total of five studies, including three randomized controlled trials (RCTs) and two retrospective studies, with a combined participation of 2325 individuals, were included. The pooled analysis indicated no significant association between suture type and PTB at less than 37 weeks of gestation (RR: 1.02, 95% CI: 0.65-1.60, p < 0.01, I = 74%). Women who received Mersilene tape had a higher risk of PTB at 34-37 weeks (RR: 2.62, 95% CI: 1.57-4.37, p = 0.69, I = 0%), but a lower risk of PTB at less than 34 weeks (RR: 0.43, 95% CI: 0.28-0.66, p = 0.66, I = 46%). No statistically significant differences were observed for PTB before 28 weeks (RR: 1, 95% CI: 0.65-1.53, p = 0.70, I = 0%), before 24 weeks (RR: 0.86, 95% CI: 0.60-1.23, p = 0.33, I = 0%), incidence of chorioamnionitis (RR: 0.97, 95% CI: 020-4.83, p < 0.01, I = 95%), neonatal intensive care unit (NICU) admission (RR: 0.79, 95% CI: 0.28-2.22, p = 0.08, I = 67%) and neonatal death (RR: 1.00, 95% CI: 0.42-2.35, p = 0.17, I = 48%).
Our findings suggest that Mersilene tape does not reduce the risk of PTB before 37, 28 or 24 weeks. We observed higher risk of preterm birth between 34 and 37 weeks with Mersilene tape but lower incidence before 34 weeks, a period with higher neonatal morbidity and mortality. Due to the limited number of studies, our results and their clinical significance should be interpreted with caution.
本研究旨在评估 Mersilene 带与替代缝线类型在延长单胎妊娠方面的有效性，以及在有宫颈环扎指征的病史、超声和检查情况下，其他妊娠和新生儿结局。
进行了系统评价，以确定比较不同缝线类型在宫颈环扎术中的相关研究。主要结局是早产（PTB）发生率 <37 周、<35 周、<28 周和 <24 周。进行了统计学分析，以确定缝线类型与各种结局之间的关系。
共纳入 5 项研究，包括 3 项随机对照试验（RCT）和 2 项回顾性研究，共纳入 2325 人。汇总分析表明，缝线类型与妊娠 37 周前的早产（RR：1.02，95%CI：0.65-1.60，p<0.01，I²=74%）无显著相关性。使用 Mersilene 带的女性发生妊娠 34-37 周的早产风险较高（RR：2.62，95%CI：1.57-4.37，p=0.69，I²=0%），但发生妊娠 34 周前的早产风险较低（RR：0.43，95%CI：0.28-0.66，p=0.66，I²=46%）。在妊娠 28 周前（RR：1，95%CI：0.65-1.53，p=0.70，I²=0%）和妊娠 24 周前（RR：0.86，95%CI：0.60-1.23，p=0.33，I²=0%）、绒毛膜羊膜炎发生率（RR：0.97，95%CI：0.20-4.83，p<0.01，I²=95%）、新生儿重症监护病房（NICU）入住率（RR：0.79，95%CI：0.28-2.22，p=0.08，I²=67%）和新生儿死亡率（RR：1.00，95%CI：0.42-2.35，p=0.17，I²=48%）方面，缝线类型之间无统计学差异。
我们的研究结果表明，Mersilene 带并不能降低妊娠 37 周、28 周或 24 周前的早产风险。我们观察到 Mersilene 带与妊娠 34-37 周之间的早产风险较高，但妊娠 34 周前的早产发生率较低，这一时期新生儿发病率和死亡率较高。由于研究数量有限，我们的结果及其临床意义应谨慎解读。
