Wang Jing, Rong Hui-Juan, Wang Xiao-Mei, Shi Guo-Yuan, Song Wen-Hui
The Fifth Obstetrical Department, Shijiazhuang Fourth Hospital, Shijiazhuang, China.
Obstetrical Department, Shijiazhuang Fourth Hospital, Shijiazhuang, China.
J Obstet Gynaecol. 2025 Dec;45(1):2549996. doi: 10.1080/01443615.2025.2549996. Epub 2025 Sep 3.
Preterm birth is the leading cause of neonatal mortality and long-term health complications. Cervical cerclage (CC) represents a critical intervention for extending pregnancy duration and enhancing neonatal survival in patients diagnosed with cervical insufficiency. The aim of this study was to identify risk factors for preterm birth through a meta-analysis comparing outcomes between preterm and full-term deliveries following non-emergency CC.
PubMed, EMBASE, Cochrane Library, Web of Science (WOS), and Scopus were searched to identify studies fulfilling predefined inclusion and exclusion criteria on 31 March 2025. The primary outcome measure was the preterm birth rate, which was calculated as the proportion of preterm birth cases in the total sample size. The impact of various risk factors on preterm birth was further analysed.
A total of 45 studies were included, and the meta-analysis revealed that the aggregate preterm birth rate at 37 weeks was approximately 48.09% following CC. Compared with twin pregnancies, singleton pregnancies were associated with a lower risk of preterm birth (odds ratio [OR]: 0.71; 95% CI: 0.55-0.91; = 0.008). Among surgery-related factors, CC indicated by physical examination poses a greater risk. Short cervical length prior to CC and elevated inflammatory markers, such as C-reactive protein (CRP), were significantly associated with preterm birth (OR: 0.79; 95% CI: 0.66-0.95; = 0.011).
This study identified critical risk factors for preterm birth following CC, including physical examination indications, a cervical length ≤ 1.5 cm, cervical dilatation, and CRP abnormalities. These findings are instrumental in identifying high-risk individuals and guiding effective medical resource allocation. However, due to study limitations, large-scale studies with multiple PTB cut-off timepoints and comprehensive analyses of risk factors are necessary to refine preventive and therapeutic approaches for preterm birth.
早产是新生儿死亡和长期健康并发症的主要原因。宫颈环扎术（CC）是延长妊娠时间和提高诊断为宫颈机能不全患者新生儿存活率的关键干预措施。本研究的目的是通过荟萃分析比较非紧急宫颈环扎术后早产和足月分娩的结局，以确定早产的危险因素。
检索了PubMed、EMBASE、Cochrane图书馆、科学网（WOS）和Scopus，以识别在2025年3月31日符合预定义纳入和排除标准的研究。主要结局指标是早产率，计算方法为早产病例数在总样本量中的比例。进一步分析了各种危险因素对早产的影响。
共纳入45项研究，荟萃分析显示宫颈环扎术后37周的总早产率约为48.09%。与双胎妊娠相比，单胎妊娠早产风险较低（优势比[OR]：0.71；95%可信区间：0.55-0.91；P = 0.008）。在手术相关因素中，体格检查提示的宫颈环扎术风险更大。宫颈环扎术前宫颈长度短和炎症标志物如C反应蛋白（CRP）升高与早产显著相关（OR：0.79；95%可信区间：0.66-0.95；P = 0.011）。
本研究确定了宫颈环扎术后早产的关键危险因素，包括体格检查指征、宫颈长度≤1.5 cm、宫颈扩张和CRP异常。这些发现有助于识别高危个体并指导有效的医疗资源分配。然而，由于研究局限性，有必要进行具有多个早产截止时间点的大规模研究并对危险因素进行综合分析，以完善早产的预防和治疗方法。
