Ni Xiaotian, Lei Shengyao, Li Shen, Yang Xiaoning, Li Xiaona, Gao Yijie, Su Xiujuan, Liu Yun, Liu Ming, Duan Tao
Department of Obstetrics, Shanghai East Hospital, Tongji University School of Medicine, Number 1800 Yuntai Road, Shanghai, China.
Department of Obstetrics, Rizhao People's Hospital, Number 126 Tai'an Road, Rizhao, Shandong, China.
BMC Pregnancy Childbirth. 2025 Mar 18;25(1):310. doi: 10.1186/s12884-025-07432-3.
To compare different periods of cerclage placement in preventing preterm birth in singleton pregnancies complicated by cervical incompetence.
This retrospective cohort study was conducted at a tertiary hospital in Shanghai, China. A total of 499 singleton pregnancies undergoing prophylactic cervical cerclage between January 1, 2021, and June 30, 2023, at Shanghai East Hospital were included in the study. Participants were classified into the early cerclage group (cerclage performed at 11 to 15 weeks of gestation) and the late cerclage group (cerclage performed at 16 to 19 weeks of gestation).
The median gestational ages at delivery were similar between the early cerclage group and the late cerclage group (median (IQR) 38.1 (36.6-39.1) vs. 38.3 (37.1-39.0) weeks, p = 0.568). There was no difference in preterm birth rates of < 37 (28.0%, 93/332 vs. 21.0%, 35/167, p = 0.089), < 34 (14.8%, 49/332 vs. 11.4%, 18/167, p = 0.218), or < 28 (6.9%, 23/332 vs. 3.0%, 5/167, p = 0.072) weeks of gestation between the early cerclage group and the late cerclage group. The incidence rates of chorioamnionitis, premature rupture of membranes, and cesarean section were comparable between the two groups. As a primary indicator of neonatal outcomes, the survival rates of newborns at three months post-delivery were similar between the early and late cerclage groups (94.6%, 314/332 vs. 98.2%, 164/167, p = 0.061). Birth weights of newborns in the early and late cerclage groups were not significantly different (median (IQR) 3080.0 (2652.5-3450.0) vs. 3210.0 (2600.0-3550.0) g, p = 0.100). The incidence rate of 5-minute Apgar scores < 7 in the late cerclage group was significantly lower than that in the early cerclage group (1.8%, 3/167 vs. 6.3%, 21/332, p = 0.026). The incidence rates of neonatal intensive care unit admission, and respiratory distress syndrome were similar between the two groups.
Our retrospective study demonstrated that the efficacy and risk of prophylactic cervical cerclage performed at 16 to 19 weeks of gestation were comparable to those of earlier cerclage performed at 11 to 15 weeks. Our study provided robust evidence supporting the safety and clinical feasibility of late cerclage in preventing preterm birth, which offers valuable insights into optimizing the cerclage period for high-risk pregnancies.
比较不同时期进行宫颈环扎术对单胎妊娠合并宫颈机能不全预防早产的效果。
本回顾性队列研究在中国上海的一家三级医院开展。2021年1月1日至2023年6月30日期间在上海东方医院接受预防性宫颈环扎术的499例单胎妊娠纳入研究。参与者被分为早期环扎组（在妊娠11至15周进行环扎）和晚期环扎组（在妊娠16至19周进行环扎）。
早期环扎组和晚期环扎组的中位分娩孕周相似（中位数（四分位间距）38.1（36.6 - 39.1）周对38.3（37.1 - 39.0）周，p = 0.568）。早期环扎组和晚期环扎组妊娠<37周（28.0%，93/332对21.0%，35/167，p = 0.089）、<34周（14.8%，49/332对11.4%，18/167，p = 0.218）或<28周（6.9%，23/332对3.0%，5/167，p = 0.072）的早产率无差异。两组的绒毛膜羊膜炎、胎膜早破和剖宫产发生率相当。作为新生儿结局的主要指标，早期和晚期环扎组产后三个月新生儿存活率相似（94.6%，314/332对98.2%，164/167，p = 0.061）。早期和晚期环扎组新生儿出生体重无显著差异（中位数（四分位间距）3080.0（2652.5 - 3450.0）克对3210.0（2600.0 - 3550.0）克，p = 0.100）。晚期环扎组5分钟阿氏评分<7分的发生率显著低于早期环扎组（1.8%，3/167对6.3%，21/332，p = 0.026）。两组新生儿重症监护病房入住率和呼吸窘迫综合征发生率相似。
我们的回顾性研究表明，妊娠16至19周进行预防性宫颈环扎术的疗效和风险与妊娠11至15周进行早期环扎相当。我们的研究提供了有力证据支持晚期环扎预防早产的安全性和临床可行性，为优化高危妊娠的环扎时机提供了有价值的见解。
