Department of Obstetrics and Gynecology and Reproductive Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX.
Department of Obstetrics and Gynecology and Reproductive Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX.
Am J Obstet Gynecol MFM. 2024 Nov;6(11):101496. doi: 10.1016/j.ajogmf.2024.101496. Epub 2024 Oct 5.
In asymptomatic women with cervical length ≤10 mm, vaginal progesterone has a limited effect in reducing the rate of preterm delivery.
This study aimed to estimate the rate of preterm delivery and mean latency period to delivery in asymptomatic women with no history of preterm delivery and a cervical length of ≤10.0 mm undergoing or not undergoing cerclage and who were not treated with vaginal progesterone.
This was a retrospective analysis of asymptomatic patients with singleton pregnancies and no history of preterm delivery with an incidental finding of a cervical length of ≤10.0 mm measured by transvaginal ultrasound during midtrimester scan. Of note, 56 patients (63.6%) underwent cerclage placement and 32 patients (36.4%) did not, none of them received vaginal progesterone. Patients with evidence of advanced dilation, prolapsing membranes, ruptured membranes, or positive signs of infection were not candidates for cerclage placement and were excluded from the analysis. Differences in the prevalence of preterm delivery, mean gestational age at delivery, and mean latency from very short cervix identification to delivery between the 2 groups were calculated. Associations between cerclage and preterm delivery adjusted for maternal characteristics and fetal weight were estimated.
The median gestational ages at the time of cervical length measurement were 20 6/7 weeks (interquartile range, 17 5/7 to 23 3/7) in the cerclage group and 21 5/7 weeks (interquartile range, 17 6/7 to 23 6/7) in the no-cerclage group (P=.02). No difference in cervical length was observed between patients who had a cerclage (5.9±3.1 mm) and those who did not have a cerclage (6.5±3.2 mm) (P=.4). The prevalence of preterm delivery in women with cerclage vs women without cerclage was as follows: PTD at <37 weeks of gestation (31/56 [55.3%] in the cerclage group vs 28/32 [87.5%] in the no-cerclage group; adjusted odds ratio, 0.17; 95% confidence interval, 0.05-0.62; P=.008), PTD at ≤34 weeks of gestation (27/56 [48.2%] in the cerclage group vs 24/32 [75.0%] in the no-cerclage group; adjusted odds ratio, 0.16; 95% confidence interval, 0.05-0.55; P=.02), and PTD at ≤28 weeks of gestation (19/56 [33.9%] in the cerclage group vs 22/32 [68.7%] in the no-cerclage group; adjusted odds ratio, 0.15; 95% confidence interval, 0.05-0.51; P=.002). The median gestational ages at delivery were 32 6/7 weeks (interquartile range, 19 1/7 to 40 1/7) in the cerclage group and 28 1/7 weeks (interquartile range, 20 1/7 to 40 2/7) in the no-cerclage group (P=.001). The median latencies from the time of cervical length measurement to delivery were 84 days (interquartile range, 8-144) in the cerclage group and 43 days (interquartile range, 1-146) in the no-cerclage group (P=.003).
Among low-risk asymptomatic women with a very short cervix (≤10.0 mm) in the midtrimester of pregnancy, women treated with cerclage have an increased latency to delivery and a lower prevalence of preterm delivery than those treated with expectant management.
在无症状且宫颈长度≤10mm 的女性中，阴道孕酮在降低早产率方面效果有限。
本研究旨在评估无早产史且宫颈长度≤10.0mm 的无症状女性的早产率和平均潜伏期，这些女性接受或未接受宫颈环扎术且未接受阴道孕酮治疗。
这是一项回顾性分析，纳入了在中孕期经阴道超声检查中偶然发现宫颈长度≤10.0mm 的单胎妊娠且无早产史的无症状患者。值得注意的是，56 名患者（63.6%）接受了宫颈环扎术，32 名患者（36.4%）未接受宫颈环扎术，他们均未接受阴道孕酮治疗。有宫颈扩张、胎膜脱垂、胎膜破裂或有感染迹象的患者不符合宫颈环扎术的适应证，因此被排除在分析之外。计算了两组间早产、分娩时的平均胎龄和从宫颈短至分娩的平均潜伏期的差异。估计了经产妇特征和胎儿体重调整后的宫颈环扎术与早产的相关性。
在宫颈长度测量时的中位孕龄分别为环扎组 20 6/7 周（四分位间距 17 5/7-23 3/7）和非环扎组 21 5/7 周（四分位间距 17 6/7-23 6/7）（P=.02）。有环扎术的患者（5.9±3.1mm）与无环扎术的患者（6.5±3.2mm）的宫颈长度无差异（P=.4）。环扎组与非环扎组的早产发生率如下：<37 周的早产（环扎组 31/56 [55.3%] vs 非环扎组 28/32 [87.5%]；调整后的优势比，0.17；95%置信区间，0.05-0.62；P=.008）、≤34 周的早产（环扎组 27/56 [48.2%] vs 非环扎组 24/32 [75.0%]；调整后的优势比，0.16；95%置信区间，0.05-0.55；P=.02）和≤28 周的早产（环扎组 19/56 [33.9%] vs 非环扎组 22/32 [68.7%]；调整后的优势比，0.15；95%置信区间，0.05-0.51；P=.002）。分娩时的中位孕龄分别为环扎组 32 6/7 周（四分位间距 19 1/7-40 1/7）和非环扎组 28 1/7 周（四分位间距 20 1/7-40 2/7）（P=.001）。从宫颈长度测量到分娩的中位潜伏期分别为环扎组 84 天（四分位间距 8-144）和非环扎组 43 天（四分位间距 1-146）（P=.003）。
在中孕期宫颈长度较短（≤10.0mm）且无早产史的低危无症状女性中，与期待治疗相比，接受宫颈环扎术治疗的女性分娩潜伏期更长，早产率更低。
