Abelman Sarah H, Jackson Frank I, Keller Nathan A, Chen Julie, Bracero Luis A, Wetcher Cara S, Blitz Matthew J
Northwell, New Hyde Park, NY (Abelman, Jackson, Keller, Chen, Bracero, Wetcher, Blitz).
Department of Obstetrics and Gynecology, South Shore University Hospital, Bay Shore, NY (Abelman, Jackson, Keller, Bracero, Wetcher, Blitz).
AJOG Glob Rep. 2025 May 30;5(3):100523. doi: 10.1016/j.xagr.2025.100523. eCollection 2025 Aug.
There is no clear consensus on the urgency of ultrasound-indicated cerclage placement after sonographic diagnosis of a short cervix, and it remains uncertain whether immediate cerclage placement prolongs gestation and improves pregnancy outcomes compared to scheduling within a reasonable timeframe.
This study aimed to determine whether the time interval between the sonographic diagnosis of a short cervix and transvaginal cerclage placement is associated with gestational age at delivery and preterm birth.
This retrospective cohort study included all patients who received an ultrasound-indicated cerclage between January 2018 and December 2023 within a large New York health system. Patients were categorized into two groups: those with a history of preterm birth and a short cervix (<25 mm) and those with no prior preterm birth but a very short cervix (<10 mm). The primary exposure was the time interval between diagnosis of a short cervix (ie, decision for cerclage) and cerclage placement, with expedited placement defined as within 1 day for patients without prior preterm birth, and within 5 days for those with prior preterm birth. These cutoffs were determined based on the median time-to-cerclage (days) observed within our study population for each cohort and rounded to the nearest day. The primary outcome was gestational age at delivery, with secondary outcomes including latency to delivery, as well as preterm birth at <37, <34, and <32 weeks. Statistical analyses included linear mixed model regression and multivariate logistic regression, adjusting for body mass index, gestational age at diagnosis, and shortest cervical length prior to cerclage. Data were analyzed using R version 4.3.1. Statistical significance was defined as <.05.
A total of 125 patients were included, with 83 having a cervical length <10 mm and no prior preterm birth, and 42 having a cervical length <25 mm with a history of preterm birth. In the group without a prior preterm birth, the mean cervical length before cerclage was 6.3±2.4 mm, and the mean gestational age at cerclage placement was 21.0±1.7 weeks. Overall, 74.7% received expedited cerclage placement (≤1 day), while 25.3% underwent routine placement. Gestational age at delivery and preterm birth rates were similar between the expedited and routine placement groups. In the group with a history of preterm birth, the mean cervical length before cerclage was 18.2±5.8 mm, with cerclage placed at a mean gestational age of 19.8±2.6 weeks. Overall, 45.2% underwent expedited placement (≤5 days), while 54.8% had routine placement. A statistically significant difference in gestational age at delivery was observed between groups (36.9±2.5 weeks vs 36.9±3.0 weeks, =.04), but this difference was not clinically meaningful.
Overall, expedited cerclage placement did not improve pregnancy outcomes in either group, suggesting that immediate placement may not be necessary and that scheduling within a reasonable timeframe is appropriate.
超声诊断宫颈短缩后，对于超声引导下宫颈环扎术的紧迫性尚无明确共识，与在合理时间内安排手术相比，立即进行宫颈环扎术是否能延长孕周并改善妊娠结局仍不确定。
本研究旨在确定超声诊断宫颈短缩与经阴道宫颈环扎术之间的时间间隔是否与分娩孕周及早产相关。
这项回顾性队列研究纳入了2018年1月至2023年12月在纽约一个大型医疗系统内接受超声引导下宫颈环扎术的所有患者。患者分为两组：有早产史且宫颈短缩（<25 mm）的患者，以及无早产史但宫颈极短（<10 mm）的患者。主要暴露因素是宫颈短缩诊断（即决定行宫颈环扎术）与宫颈环扎术之间的时间间隔，对于无早产史的患者，快速手术定义为在1天内进行，对于有早产史的患者，定义为在5天内进行。这些临界值是根据我们研究人群中每个队列观察到的宫颈环扎术中位时间（天）确定的，并四舍五入到最接近的一天。主要结局是分娩孕周，次要结局包括分娩潜伏期，以及<37、<34和<32周的早产。统计分析包括线性混合模型回归和多因素逻辑回归，对体重指数、诊断时的孕周以及宫颈环扎术前最短宫颈长度进行校正。使用R 4.3.1版本进行数据分析。统计学显著性定义为<.05。
共纳入12名患者，其中83名宫颈长度<10 mm且无早产史，42名宫颈长度<25 mm且有早产史。在无早产史的组中，宫颈环扎术前平均宫颈长度为6.3±2.4 mm，宫颈环扎术时平均孕周为21.0±1.7周。总体而言，74.7%的患者接受了快速宫颈环扎术（≤1天），而25.3%的患者接受了常规手术。快速手术组和常规手术组的分娩孕周和早产率相似。在有早产史的组中，宫颈环扎术前平均宫颈长度为18.2±5.8 mm，宫颈环扎术时平均孕周为19.8±2.6周。总体而言，45.2%的患者接受了快速手术（≤5天），而54.8%的患者接受了常规手术。两组之间观察到分娩孕周存在统计学显著差异（36.9±2.5周对36.9±3.0周，P =.04），但这种差异在临床上无意义。
总体而言，快速宫颈环扎术在两组中均未改善妊娠结局，这表明立即手术可能没有必要，在合理时间内安排手术是合适的。
