Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Obstetrics Unit, Department of Woman Child and Neonate, Milan, Italy.
Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Obstetrics Unit, Department of Woman Child and Neonate, Milan, Italy.
Eur J Obstet Gynecol Reprod Biol. 2024 Nov;302:249-253. doi: 10.1016/j.ejogrb.2024.09.011. Epub 2024 Sep 10.
We aimed to retrospectively evaluate obstetric and neonatal outcomes in patients who underwent ultrasound-indicated and rescue cervical cerclage and to identify predictors for cerclage failure and consequent preterm birth (PTB).
We conducted a retrospective analysis on singleton pregnancies between 16 and 27 weeks of gestation who presented with a transvaginal sonographic cervical length (TVS-CL) <25 mm and a previous PTB/second-trimester miscarriage or prolapsed amniotic membranes and/or a TVS-CL <15 mm and underwent cervical cerclage at Mangiagalli Center, Milan, between September 2011 and December 2021. Univariate and multivariate logistic regression analyses were used to identify possible predictive factors of cerclage failure.
During the study period, a total of 136 singletons met the inclusion criteria. Overall, 3 % of pregnancies did not reach fetal viability, mostly due to post-cerclage preterm premature rupture of membranes and/or chorioamnionitis. The mean gestational age at delivery was 35.9 ± 4.5 weeks. Neonates were delivered beyond 37 weeks in 63.2 % of cases, between 28 and 37 weeks in 26.5 %, and less than 28 gestational weeks in 10.3 %. At the multivariate analysis, independent risk factors for miscarriage or PTB were cervical length <10 mm (odds ratio, OR 3.44), advanced cervical dilatation (OR 4.76), and in vitro fertilization (OR 4.66). A history of previous miscarriage, premature delivery, and uterine malformations did not increase the risk of post-cerclage delivery before 37 weeks. In the preterm delivery group, 14 % of patients experienced preterm premature rupture of membranes (pPROM) and 10 % had chorioamnionitis, while no case was registered in the term delivery group. A positive vaginal swab at the time of cervical cerclage was not significantly associated with PTB at the multivariate analysis but it emerged as a significant risk factor for both chorioamnionitis (OR 11.03) and pPROM (OR 5.28).
Ultrasound-indicated and rescue cervical cerclage were effective in prolonging pregnancy, even when placed beyond 24 weeks of gestation. Preoperative cervical length of less than 10 mm, advanced dilatation, and in vitro fertilization are associated with an increased risk of cerclage failure. A positive vaginal swab before cerclage is associated with increased rates of intrauterine infectious-inflammatory processes.
本研究旨在回顾性评估超声指示和紧急宫颈环扎术的产科和新生儿结局，并确定宫颈环扎术失败和随后早产（PTB）的预测因素。
我们对 2011 年 9 月至 2021 年 12 月在米兰 Mangiagalli 中心因阴道超声宫颈长度（TVS-CL）<25mm 且有既往早产/中孕期流产史或胎膜膨出和/或 TVS-CL<15mm 而行宫颈环扎术的 16-27 孕周单胎妊娠患者进行了回顾性分析。采用单因素和多因素逻辑回归分析来确定宫颈环扎术失败的可能预测因素。
在研究期间，共有 136 例单胎妊娠符合纳入标准。总体而言，3%的妊娠未能达到胎儿存活能力，主要是由于宫颈环扎术后发生早产胎膜早破和/或绒毛膜羊膜炎。分娩时的平均孕龄为 35.9±4.5 周。新生儿在 37 周以上分娩的比例为 63.2%，在 28-37 周分娩的比例为 26.5%，在 28 周以下分娩的比例为 10.3%。多因素分析显示，宫颈长度<10mm（比值比，OR 3.44）、宫颈扩张进展（OR 4.76）和体外受精（OR 4.66）是流产或早产的独立危险因素。既往流产史、早产史和子宫畸形并未增加宫颈环扎术后 37 周前分娩的风险。在早产组中，14%的患者发生早产胎膜早破（pPROM），10%的患者发生绒毛膜羊膜炎，而在足月分娩组中未发现病例。宫颈环扎术前阴道拭子阳性与多因素分析中的早产无显著相关性，但在绒毛膜羊膜炎（OR 11.03）和 pPROM（OR 5.28）中均为显著危险因素。
超声指示和紧急宫颈环扎术可有效延长妊娠时间，即使在 24 孕周后进行环扎术。术前宫颈长度<10mm、宫颈扩张进展和体外受精与宫颈环扎术失败风险增加相关。宫颈环扎术前阴道拭子阳性与宫内感染-炎症过程发生率增加相关。
