Zhang Yayun, Zhao Zihan, Xu Jiaqi, Wu Fei, Chen Ting, Hou Shunyu, Wang Aifen
Department of Gynecology, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Gusu School, Nanjing Medical University, Suzhou, Jiangsu, 215002, China.
Mailman School of Public Health, Columbia University, 722 West 168th Street, New York, NY, 10032, USA.
BMC Pregnancy Childbirth. 2025 Jan 8;25(1):12. doi: 10.1186/s12884-025-07142-w.
This study aimed to analyze the impact of preoperative cervical length before cervical cerclage on the extension of gestational days in patients with various diagnostic types of cervical insufficiency, including obstetric history-based diagnosis, ultrasound-based diagnosis, and physical examination-based diagnosis.
168 patients were segregated into four categories based on cervical length: 0-0.4 cm, 0.5-1.4 cm, 1.5-2.4 cm, and ≥ 2.5 cm. Kaplan-Meier, linear regression curve and Cox regression analyses were used, with a focus on clinical variables, particularly cervical length and the duration of extension after cervical cerclage.
The length of the cervix prior to cervical cerclage correlated with the prognosis of 168 postoperative patients by linear regression analysis. When delivery beyond 28 or 34 weeks was set as the primary prognostic indicator, univariate Cox analysis showed that postoperative C-reactive protein (CRP) level was identified as a risk factor for gestational age extension in cervical cerclage patients. Longer cervical length was identified as a protective factor for overall gestational age extension in cervical cerclage patients. In addition, the obstetrical-history diagnosis group had a better prognosis compared to the emergency cerclage group, which had a worse prognosis compared to the ultrasound-based diagnosis group. Kaplan-Meier curve analysis of all patients revealed a statistically significant impact of different cervical lengths on the gestational age of delivery (P < 0.001). However, in the physical examination-based diagnosis group, Kaplan-Meier curve analysis demonstrated a statistically significant impact of different cervical lengths on gestational age at delivery (P = 0.006).
Longer preoperative cervical length was associated with better outcomes in terms of gestational prolongation and newborn survival after cervical cerclage.
本研究旨在分析宫颈环扎术前宫颈长度对不同诊断类型宫颈机能不全患者孕周延长的影响，这些诊断类型包括基于产科病史的诊断、基于超声的诊断和基于体格检查的诊断。
168例患者根据宫颈长度分为四类：0 - 0.4厘米、0.5 - 1.4厘米、1.5 - 2.4厘米和≥2.5厘米。采用Kaplan-Meier法、线性回归曲线和Cox回归分析，重点关注临床变量，尤其是宫颈长度和宫颈环扎术后的延长时间。
通过线性回归分析，宫颈环扎术前的宫颈长度与168例术后患者的预后相关。当以28周或34周后分娩作为主要预后指标时，单因素Cox分析显示，术后C反应蛋白（CRP）水平被确定为宫颈环扎患者孕周延长的危险因素。较长的宫颈长度被确定为宫颈环扎患者总体孕周延长的保护因素。此外，产科病史诊断组的预后优于急诊环扎组，而急诊环扎组的预后比基于超声的诊断组差。对所有患者的Kaplan-Meier曲线分析显示，不同宫颈长度对分娩孕周有统计学显著影响（P < 0.001）。然而，在基于体格检查的诊断组中，Kaplan-Meier曲线分析表明不同宫颈长度对分娩孕周有统计学显著影响（P = 0.006）。
宫颈环扎术前较长的宫颈长度与孕周延长及新生儿存活的更好结局相关。
