Lipitz S, Libshitz A, Oelsner G, Kokia E, Goldenberg M, Mashiach S, Schiff E
Department of Obstetrics and Gynecology, Chaim Sheba Medical Center, Tel Hashomer, Israel.
Am J Perinatol. 1996 Oct;13(7):419-22. doi: 10.1055/s-2007-994381.
A retrospective, descriptive study was conducted to evaluate the outcome of second-trimester, emergency cervical cerclage in patients with no history of cervical incompetence. Thirty-two women with singleton pregnancies were studied. All had undergone emergency cervical McDonald cerclage at 17 to 25 weeks' gestation because of cervical dilation and effacement. The procedure was carried out after a rest period of 6 or more hours, during which none of the patients demonstrated uterine activity. The mean procedure-to-delivery interval was 6.9 +/- 5.6 (median 5.5, range 0.2 to 18) weeks. Thirteen pregnancies (41%) terminated before 24 weeks. The mean gestational age at delivery was 28.5 +/- 5.8 weeks for the entire group, and 32.3 +/- 4.4 (range 25 to 38) weeks for the 19 who achieved viability. The mean birthweight of the live infants was 1935 +/- 958 g (median 1670, range 905 to 3710 g). Four infants died during the neonatal period. The total survival rate was 47%, and the survival rate corrected for major anomalies was 48.4%. The perinatal mortality rate was significantly higher among patients with membranes protruding through the-cervix on admission, compared to those without (75% vs 17%; p = .003). We concluded that emergency midtrimester cervical cerclage among patients with no prior evidence of cervical incompetence is associated with an approximately 50% survival rate. Membranes protruding through the dilated cervix are a poor prognostic factor for survival in these cases.
进行了一项回顾性描述性研究，以评估无宫颈机能不全病史的患者在孕中期进行紧急宫颈环扎术的结局。研究了32名单胎妊娠的女性。所有患者均因宫颈扩张和消退在妊娠17至25周时接受了紧急宫颈麦克唐纳环扎术。该手术在休息6小时或更长时间后进行，在此期间没有患者出现子宫活动。手术至分娩的平均间隔时间为6.9±5.6（中位数5.5，范围0.2至18）周。13例妊娠（41%）在24周前终止。整个组的平均分娩孕周为28.5±5.8周，19例存活的患者平均分娩孕周为32.3±4.4（范围25至38）周。存活婴儿的平均出生体重为1935±958 g（中位数1670，范围905至3710 g）。4例婴儿在新生儿期死亡。总存活率为47%，校正重大畸形后的存活率为48.4%。与未出现胎膜突出的患者相比，入院时胎膜经宫颈突出的患者围产儿死亡率显著更高（75%对17%；p = 0.003）。我们得出结论，在无先前宫颈机能不全证据的患者中，孕中期紧急宫颈环扎术的存活率约为50%。在这些病例中，胎膜经扩张的宫颈突出是存活的不良预后因素。
