111例改良McDonald宫颈环扎术患者的临床资料分析

Clinical data analysis of 111 patients with modified Mc Donald′s cervical cerclage

目的探讨改良McDonald宫颈环扎术对宫颈功能不全的治疗效果,研究我院近年宫颈机能不全发病率及其变化趋势。方法回顾2013年7月至2017年6月于我院产科住院的13 096例孕产妇,研究宫颈机能不全发病率,对111例单胎妊娠并实施改良McDonald宫颈环扎术的患者进行回顾性分析。结果 (1)2013年7月至2017年6月我院宫颈机能不全发病率约为1.8%,2013-2017年发病率分别为1.1%、1.4%、2.1%、2.2%、2.8%。(2)111例患者中,孕前BMI的平均水平为(23.7±3.2)kg/m2,孕前BMI≥24 kg/m2者28例,≥28 kg/m2者11例。(3)111例患者中足月产83例(74.8%),20例早产(18%),8例流产(7.2%),获得活婴患者达92.8%,新生儿平均出生体(3 008±636)g。(4)病史指征性环扎分娩周数、平均延长孕周数、获得活婴率、新生儿平均体质量均高于超声指征性环扎,差异有统计学意义。(5)获得活婴患者中阴道分娩63例(61.2%),其中合并宫颈裂伤15例;剖宫产术分娩40例(38.8%)。(6)111例宫颈机能不全患者中糖尿病合并妊娠(3例)和妊娠期糖尿病者(46例)共49例(44.1%),孕期合并亚临床甲状腺功能减退症患者27例(24.3%)。结论 2013年7月至2017年6月,我院宫颈机能不全发病率约为1.8%,且2013-2017年发病率呈逐年增长趋势。改良McDonald宫颈环扎术是治疗宫颈机能不全有效的手术干预方式。宫颈机能不全患者孕期易并发妊娠期糖尿病、妊娠合并亚临床甲状腺功能减退症,合理控制饮食、适度的体质量增长、定期监测甲功是良好妊娠结局的基础。

Objective To study the incidence of cervical incompetence(CI)in recent years and its trends,to investigate the advantages of modified McDonald′s cervical cerclage on patients of CI during pregnancy and postpartum.Methods A total of 13,096 pregnant women admitted to the Department of Obstetrics of the First Affiliated Hospital of Shanxi Medical University from July 2013 to June 2017 were reviewed to study the incidence of CI.A retrospective study was conducted on 111 cases of single fetal pregnancy with CI who underwent modified McDonald′s cervical cerclage.Results(1)The incidence of CI was increased and that from 2013 to 2017 was 1.1%(July to December 2013),1.4%,2.1%,2.2%,and 2.8%(January-June 2017)respectively,with an aver age of 1.8%.(2)The average BMI of 111 patients with CI before the pregnancy was(23.7±3.2)kg/m^2;BMI of 28 cases was over 24 kg/m^2,and 11 over 28 kg/m^2.(3)Among 111 patients with CI and cervical cerclage,83 cases(74.8%)had full-term birth;20 cases(18%)a premature labor and 8 cases(8.2%)a miscarriage.Of the total,92.8%of the patients had living birth with the average birth weight(3 008±636)g.(4)There were better results regarding weeks of delivery,average extend gestational age,live birth rate,and average birth weight when com pared with history-indicated cerclage and ultrasound-indicated cerclage,and the differences were statistically signif icant(P<0.05).(5)Among the patients with living birth,63 cases(61.2%)delivered by vaginal,including 15 cases with cervical laceration and 40 cases(38.8%)by cesarean section.(6)Among 111 patients with CI,there were 49 cases with diabetes mellitus,of which 46 cases were with gestational diabetes mellitus,and 27 cases with subclinical hypothyroidism during pregnancy.Conclusion With an increasing trend,the average incidence of CI in our hospital is 1.8%from July 2013 to June 2017.Modified McDonald′s cervical cerclage is an effective interven tion for the treatment of CI.CI is a great risk for GDM and subclinical hypothyroidism during the pregnancy,and diet control,moderate weight gain,regular monitoring of thyroid function are the basis for good pregnancy out comes.