Wei Minling, Yang Yang, Yang Jingyan, Zhang Songying
Center of Reproductive Medicine, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, PR China.
Key Laboratory of Reproductive Dysfunction Management of Zhejiang Province, Hangzhou, PR China.
Medicine (Baltimore). 2025 Jun 20;104(25):e42687. doi: 10.1097/MD.0000000000042687.
Cervical cerclage has been used for many years to treat cervical incompetence and reduce the rates of late abortion and preterm birth, and some women with history-indicated cerclage preferred to retain the suture in place during cesarean delivery. This study was designed to evaluate the obstetric outcomes of subsequent pregnancies in women with a prior history-indicated modified transvaginal cervicoisthmic cerclage, with particular emphasis on assessing the clinical efficacy of suture reuse. A retrospective observational study was performed from 2014 to 2021, consisted of 20 women who completed 2 pregnancies with the same cerclage suture in place. The study compared gestational age at delivery, term and post-34-week preterm delivery rates, neonatal birth weight, and survival rates between first and second pregnancies with the same suture. In the first pregnancies, the mean gestational age at delivery was 37.6 ± 0.9 weeks, with a term delivery rate of 90%, no preterm births before 34 weeks (0%), and a 100% neonatal survival rate. The second pregnancies had had a mean delivery gestational age of 36.7 ± 3.2 weeks, with a 75% term delivery rate, a 15% preterm birth rate before 34 weeks, while neonatal survival remained at 100%. The findings indicate that utilizing the same suture for history-indicated transvaginal cervicoisthmic cerclage can be effective for maintaining favorable pregnancy outcomes in both initial and subsequent pregnancies among women with cervical insufficiency. This approach may offer a viable option for preserving pregnancy outcomes in this high-risk population.
宫颈环扎术已应用多年，用于治疗宫颈机能不全并降低晚期流产和早产率，一些有病史指征行宫颈环扎术的女性更倾向于在剖宫产时保留缝线。本研究旨在评估既往有病史指征行改良经阴道宫颈峡部环扎术的女性后续妊娠的产科结局，特别强调评估缝线再利用的临床疗效。我们于2014年至2021年进行了一项回顾性观察研究，纳入了20名使用同一根环扎缝线完成两次妊娠的女性。该研究比较了两次使用同一缝线妊娠的分娩孕周、足月及34周后早产率、新生儿出生体重和存活率。首次妊娠时，平均分娩孕周为37.6±0.9周，足月分娩率为90%，34周前无早产（0%），新生儿存活率为100%。第二次妊娠的平均分娩孕周为36.7±3.2周，足月分娩率为75%，34周前早产率为15%，而新生儿存活率仍为100%。研究结果表明，对于有宫颈机能不全的女性，在有病史指征的经阴道宫颈峡部环扎术中使用同一缝线，在初次及后续妊娠中维持良好的妊娠结局均有效。这种方法可能为在这一高危人群中保留妊娠结局提供一个可行的选择。
