不同妊娠期经阴道子宫颈环扎术后妊娠结局分析

Objective?To investigate the differences in pregnancy outcomes between the different transvaginal cervical cerclage. Methods?This retrospective study included pregnant women with cervical insufficiency admitted to Peking University People’s Hospital between January 2013 and September 2021. There were 37 patients in the study group underwent Shirodkar’s cerclage, and 32 patients in the control group underwent McDonald’s cerclage. The pregnancy outcomes were compared. Results?Compared with the control group, the study group showed more weight gain during pregnancy[(12.66±6.00) kg/m2, (9.21±5.79) kg/m2; P=0.022], long operation time [45 min(40-51.3 min) vs. 20.5 min (17.3-25.0), P<0.001] and later cerclage removal [36.71(36.14-37) vs. 34.43(24.32-36.75), P=0.003]. Gestational weeks at delivery in the Shirodkar group were more advanced than in the McDonald group[38.9 (36.3-39.8) vs.35.0 (30.1-39.0), P=0.005]. Compared with the McDonald group, the Shirodkar group had higher incidences of deliveries≥28 gestational weeks (91.9% vs. 68.8%, P=0.027), deliveries≥34 gestational weeks (81.1% vs. 59.4%, P=0.037), deliveries≥37 gestational weeks (67.6% vs. 37.5%, P<0.001), induced labor (43.2% vs. 12.5%, P=0.006), and fewer fetal loss (8.1% vs. 31.3%, P=0.017). Multivariate regression analysis of preterm birth factors showed that Shirodkar cervical cerclage was a protective factor to reduce the incidence of preterm birth(OR=0.063, 95%CI: 0.008, 0.492, P=0.008). Conclusion?Shirodkar cerclage appears to have advantages over McDonald cerclage in preventing fetal loss and a fewer frequency of preterm deliveries.     

Transabdominal cerclage in the management of cervical pregnancy: three case reports

We report three cases of cervical pregnancy, managed by transabdominal uterine cerclage and cervical curettage: each one was followed by a successful pregnangy. A review of the literature is presented. Correspondence to: G. Loverro     

经阴宫颈峡部环扎术106例妊娠结局分析

目的探讨经阴宫颈峡部环扎术后的妊娠过程及结局。方法对2003-2011年北京安太医院有传统经阴缝扎术失败或宫颈先天发育不良引起晚期流产史的106例患者,在妊娠期行经阴宫颈峡部环扎术,分析其妊娠过程及结局。结果胎儿存活率100%。早产率32%,孕周<30周孕妇的早产率为21%。严重并发症包括术中膀胱损伤1例和分娩时宫颈撕裂2例。轻微并发症8例,包括环扎血肿、暂时性尿潴留和耻骨联合痛。结论经阴宫颈峡部环扎术妊娠结局良好,是一种安全简便的术式。     

Successful twin pregnancy after vaginal radical trachelectomy using transabdominal cervicoisthmic cerclage

The outcome of vaginal radical trachelectomy (VRT) for the management of early cervical cancer is comparable to that achieved with radical hysterectomy. Although VRT preserves the potential for pregnancy, the outcome of twin pregnancies following VRT is poor. We report a successful twin pregnancy after VRT using transabdominal cervicoisthmic cerclage.     

Positive vaginal culture at rescue cerclage predicts subsequent preterm delivery

Purpose: This retrospective case-control study is aimed to extract predictors of preterm delivery after rescue cerclage.

Materials and methods: We collected the data from all the pregnant women who underwent rescue cerclage before 26⁺⁰ gestational weeks at our facility between July 2006 and July 2016. These women were divided into “delivery at <34 weeks” group (n?=?12) and “delivery at ≥34 weeks” group (n?=?12). Multiple factors that had been detected at the time of cerclage were compared between these two groups.

Results: “Gestational weeks at cerclage ≥23” and “positive vaginal culture at cerclage” were significantly more prevalent in the “delivery at <34 weeks” group than in the “delivery at ≥34 weeks” group. “Prolapsed membranes at cerclage” tended to be more prevalent in the “delivery at <34 weeks” group than in the “delivery at ≥34 weeks” group. “Positive vaginal culture at cerclage” was the only independent risk factor associated with eventual preterm delivery before 34 gestational weeks.

Conclusions: Simple aerobic bacterial culture of the vaginal swab sampled at the time of cerclage could be used as a reliable test to predict subsequent preterm delivery before 34 gestational weeks.     

Obstetrical outcomes of emergency compared with elective cervical cerclage

Objective: To study obstetric outcomes of emergency cerclage compared with elective cerclage.

Study design: Retrospective cohort study of pregnancy outcomes of patients who underwent cervical cerclage, performed according to ACOG guidelines, between January 2006 and December 2014. Patients who underwent emergency cerclage, due to cervical shortening or cervical dilation (emergency cerclage group) were compared with patients who underwent history-indicated cerclage (elective cerclage group). Emergency cerclage was not performed in patients with uterine contractions, vaginal bleeding, or signs of chorioamnionitis. Procedure-related complications were defined as rupture of membranes or chorioamnionitis occurring after cerclage placement and before 24 weeks of gestation.

Results: Overall, 154 patients with elective cerclage and 47 patients with emergency cerclage were included. Mean gestational age at cerclage operation was 13.1?±?1 and 20.2?±?3 weeks, respectively. There were no differences between the emergency cerclage group and the elective cerclage group regarding mean gestational age at delivery (36.1?±?3 versus 35.6?±?3, respectively, p?=?0.7), rate of deliveries beyond 34 weeks of gestation (81.81% versus 78.72%, respectively, p?=?0.67), rate of deliveries beyond 37 weeks of gestation (64.93% versus 59.57%, respectively, p?=?0.6), cesarean deliveries (33.11% versus 39.13%, p?=?0.48, respectively), or birthweight (2848 versus 2862 grams, respectively, p?=?0.9). Regarding procedure-related complications, there were no differences between the elective and the emergency cerclage groups in the rate of chorioamnionitis (1.29% versus 4.34%, respectively, p?=?0.22), or ruptured membranes (1.29% versus 4.34%, respectively, p?=?0.22).

Conclusion: Pregnancy outcomes of emergency cerclage are comparable with those of elective cerclage.     

宫颈环扎术后妊娠患者的孕期管理

宫颈环扎术作为预防宫颈机能不全导致早产的治疗手段之一,已广泛用于临床,对于其术后患者是否需使用保胎药物,围术期抗生素的使用及终止妊娠的时机和方式等问题值得临床医生关注和讨论。本文将结合国内外现有证据及笔者的临床经验就宫颈环扎术后患者管理的一些重要问题作初步探讨。     

Comparison of elective and empiric cerclage and the role of emergency cerclage

We describe the maternal, obstetric, and neonatal outcomes of patients undergoing elective, empiric, and emergency cervical cerclage at our institution in an attempt to determine predictive factors for adverse perinatal and maternal outcomes. A retrospective chart review was conducted on patients who underwent cervical cerclage placement over a 7-year time span. Of 55 charts, 40 contained complete peripartum data satisfactory for review; 7 elective, 15 empiric, and 18 emergency cerclages were analyzed. There was no perinatal mortality in the elective group, and 5/7 patients delivered at term. The empiric population experienced a 20% neonatal mortality; 6/15 gestations progressed to term. The perinatal mortality was 44% in the emergency group and 2/18 patients delivered at term. Relative to neonatal outcome, elective cerclage was statistically significantly better than emergent cerclage; there was no statistically significant difference between the elective and empiric groups nor between the empiric and emergent groups. This relatively small series with a large number of variables appeared to favor an elective procedure rather than an empiric one. Although emergent cerclage was associated with only a 56% neonatal survival, it did have value in some patients.     

Outcomes of ultrasound-indicated cerclage in twin pregnancies with a short cervical length

ObjectiveTo investigate the outcomes of ultrasound-indicated cerclage in dichorionic-diamniotic (DCDA) twin pregnancies with a short cervical length.Materials and methodsThis was a retrospective cohort study of DCDA twin pregnancies with a short cervical length (≤25 mm) from January 2000 to July 2017 to compare maternal and neonatal outcomes. Additional sub-analysis was performed by dividing the patients into two subgroups by a cervical length ≤15 mm and between 16 and 25 mm.ResultsOne hundred and eight women were initially diagnosed with twin pregnancies and cervical insufficiency. After excluding cases not meeting the study criteria, 46 women were recruited for analysis, of whom 33 underwent ultrasound-indicated cerclage. The delivery age of the cerclage group was significantly later than the non-cerclage group (34.85 ± 3.91 versus 31.08 ± 5.25 weeks, p = 0.011), and the latency was significantly longer in the cerclage group than in the non-cerclage group (86.09 ± 41.32 versus 52.31 ± 33.24 days, p = 0.014). Sub-analysis revealed that these benefits were significant in the subgroup of a cervical length ≤15 mm. Both first twin (twin A) and second twin (twin B) had a significantly decreased rate of neonatal intensive care unit admission in the cerclage group. However, twin A had more promising outcomes with significantly decreased rates of neonatal respiratory distress syndrome (6.7% versus 50.0%, p = 0.004) and sepsis (0% versus 25.0%, p = 0.019).ConclusionUltrasound-indicated cerclage in DCDA twin pregnancies can decrease preterm birth and prolong the latency. It also decreases neonatal morbidity, and is especially beneficial for twin A.     

Cervical cerclage for prevention of preterm birth in women with twin pregnancy.

OBJECTIVE: To compare the effect of elective cervical cerclage in women with twin pregnancy on gestational age at time of delivery. METHOD: In a pragmatic fashion women in Abha Maternity Hospital, Saudi Arabia with twin gestations were allocated to receive either an elective cerclage (group I) or no cerclage (group II). Elective cerclage was performed at 12 to 14 weeks of gestation after sonographic examination of the fetus to confirm gestational age and exclude major congenital anomalies. In all cases, follow up of the pregnancy was continued until delivery. RESULTS: Of the 176 twin pregnancies included, cerclage was performed in 76 women, and no cerclage in 100 women. In Group I: 12 pregnancies ended in spontaneous miscarriage, 37 in preterm labor, and 27 women reached full term. There were a total of 106 live births in 62 women. In Group II: 8 women aborted, 44 women ended in preterm labor and 48 women reached full term. There were a total of 160 live births in 89 women. The gestational age at delivery ranged from 20 to 41 weeks. Multiple regression analysis did not show association between cerclage and time of delivery, although a trend was observed (P=0.056). CONCLUSION: Elective cerclage contributes little in prolongation of gestational age at the time of delivery in women with twin pregnancy, especially in women of high parity. Those with a previous history of preterm labor may be a subgroup that could benefit from elective cerclage.     

Emergency cervical cerclage: Predictors of success

Objective.?To document predictors of success of emergency cervical cerclage.

Methods.?This is a retrospective cohort study of 8 years at a university hospital. Emergency cerclage was defined as when the membranes were at or beyond the external os and was only performed where evidence of infection or labour were absent. Outcomes used were interval between cerclage and delivery, gestation at delivery; a ‘good outcome’ was defined as delivery after 32 weeks and healthy at discharge. Predictive factors for a successful pregnancy outcome were analysed using odds ratios (OR) with 95% confidence intervals.

Results.?Forty-five emergency cerclages were performed, including 11 twin pregnancies. Twenty-one (47%) had a ‘good outcome’, including two twin pregnancies; 20 (44%) pregnancies reached 36 weeks. In 79.2% of ‘poor outcomes’ chorioamnionitis was found. Prolapsed membranes, advanced cervical dilatation, maternal symptoms and equivocal markers of infection were associated with a poor outcome, but not consistently enough to dictate management.

Conclusions.?Given the poor natural history of an open external os, emergency cerclage appears beneficial. That this might apply to twin pregnancies has implications for their management. Although success is indeed partly predictable, it can still be achieved even when there is advanced dilatation, prolapse, bleeding or discomfort.