Bobotis Stergios, Arsenaki Elisavet, Hamilton Kirsty, Vougiouklaki Evgenia-Stavroula, Paraskevaidi Maria, Chilcott Ian, Kyrgiou Maria, Terzidou Vasso, Savvidou Makrina, Kechagias Konstantinos S
Department of Surgery, Tunbridge Well and Maidstone NHS Trust, Tunbridge Wells, United Kingdom.
Department of Metabolism, Digestion and Reproduction, Faculty of Medicine, Imperial College London, London, United Kingdom.
Am J Obstet Gynecol. 2025 Dec;233(6):572-580.e26. doi: 10.1016/j.ajog.2025.07.026. Epub 2025 Jul 17.
The aim of this meta-analysis was to compare the impact of transvaginal and transabdominal cervical cerclage on obstetrical and perinatal outcomes in women at risk for preterm birth.
PubMed, Scopus, and Web of Science electronic databases were screened up to January 2024.
Studies were included if they evaluated women at risk for preterm birth who underwent either a transvaginal or a transabdominal cervical cerclage. The meta-analysis included both randomized and observational studies that assessed the impact of different surgical approaches on obstetrical and neonatal outcomes.
Data extraction and quality assessment were performed in duplicates using the Risk of Bias 2 and Risk Of Bias In Non-randomized Studies of Interventions tools. The pooled risk ratios and 95% confidence intervals were calculated using a random-effects model.
Our main analysis, which included 12 studies, showed that a transabdominal cerclage, which included both the open and laparoscopic approaches, was associated with a lower rate of perinatal mortality than a transvaginal cerclage (8 studies, 975 participants, risk ratio, 0.36; 95% confidence interval, 0.14-0.95; I=50%; τ=0.56). The rate of preterm birth was also lower in the transabdominal cerclage group than in the transvaginal cerclage group (8 studies, 932 participants, risk ratio, 0.49; 95% confidence interval, 0.25-0.94; I=73%; τ=0.36). The confidence in this meta-analysis was low according to the Grading of Recommendations, Assessment, Development, and Evaluations because of the presence of considerable heterogeneity. Our secondary analysis showed that the rate of perinatal mortality was similar among patients who underwent an open transabdominal cerclage and those who underwent a laparoscopic transabdominal cerclage (3 studies, 122 participants, risk ratio, 1.24; 95% confidence interval, 0.35-4.35; I=0%; τ=0). In addition, the rate of preterm birth was similar among patients who underwent an open transabdominal cerclage and those who underwent a laparoscopic transabdominal cerclage (2 studies, 99 participants, risk ratio, 1.23; 95% confidence interval, 0.60-2.54; I=40%; τ=0).
The results of this meta-analysis suggest that a transabdominal cerclage may have the potential to outperform a transvaginal cerclage in reducing perinatal mortality and preterm birth rates in patients at high risk for preterm birth, particularly those with a history of failed transvaginal cerclage or anatomic contraindications to vaginal placement. However, the data remain inconclusive considering the observational nature and heterogeneity of the included studies. Given the frequency of prematurity and the increased associated morbidity and mortality, a transabdominal cerclage deserves further study as a potential therapeutic option for these patients.
本荟萃分析旨在比较经阴道宫颈环扎术和经腹宫颈环扎术对早产风险女性的产科和围产期结局的影响。
截至2024年1月，对PubMed、Scopus和Web of Science电子数据库进行了筛选。
纳入评估接受经阴道或经腹宫颈环扎术的早产风险女性的研究。该荟萃分析包括评估不同手术方式对产科和新生儿结局影响的随机对照研究和观察性研究。
使用《偏倚风险2》和《非随机干预研究中的偏倚风险》工具进行重复的数据提取和质量评估。采用随机效应模型计算合并风险比和95%置信区间。
我们的主要分析纳入了12项研究，结果显示，包括开放手术和腹腔镜手术的经腹环扎术与经阴道环扎术相比，围产期死亡率较低（8项研究，975名参与者，风险比为0.36；95%置信区间为0.14 - 0.95；I² = 50%；τ² = 0.56）。经腹环扎术组的早产率也低于经阴道环扎术组（8项研究，932名参与者，风险比为0.49；95%置信区间为0.25 - 0.94；I² = 73%；τ² = 0.36）。根据推荐分级、评估、制定与评价，由于存在相当大的异质性，该荟萃分析的可信度较低。我们的次要分析表明，接受开放经腹环扎术的患者和接受腹腔镜经腹环扎术的患者的围产期死亡率相似（3项研究，122名参与者，风险比为1.24；95%置信区间为0.35 - 4.35；I² = 0%；τ² = 0）。此外，接受开放经腹环扎术的患者和接受腹腔镜经腹环扎术的患者的早产率相似（2项研究，99名参与者，风险比为1.23；95%置信区间为0.60 - 2.54；I² = 40%；τ² = 0）。
该荟萃分析结果表明，对于早产高风险患者，尤其是有经阴道环扎术失败史或阴道放置存在解剖学禁忌证的患者，经腹环扎术在降低围产期死亡率和早产率方面可能优于经阴道环扎术。然而，考虑到纳入研究的观察性性质和异质性，数据仍无定论。鉴于早产的发生率以及相关发病率和死亡率的增加，经腹环扎术作为这些患者的潜在治疗选择值得进一步研究。
