宫颈功能不全及宫颈环扎术对极低出生体质量新生儿的影响

Effect of cervical insufficiency and cervical cerclage on very low birth weight newborns

目的探讨宫颈功能不全及宫颈环扎术对极低出生体质量新生儿的影响。方法选择2014年1月至2018年3月在海南省人民医院出生的极低出生体质量新生儿作为研究对象,根据母亲是否存在宫颈功能不全分为A组(母亲存在宫颈功能不全)和B组(母亲不存在宫颈功能不全)。观察母亲宫颈功能不全及宫颈环扎术对新生儿不良产后结局的影响。结果共纳入323例极低体质量新生儿,其中A组新生儿共57例,占17.65%,B组新生儿共266例,占82.35%。A组和B组孕周、胎膜早破、妊娠期高血压差异有统计学意义(P<0.05),病儿体质量、性别、分娩方式、新生儿窘迫综合征、绒毛膜羊膜炎、妊娠期糖尿病、产前激素治疗、早产儿视网膜病变、支气管肺发育不良、脑室周围白质软化、Ⅲ度以上颅内出血、新生儿坏死性小肠结肠炎、重度窒息、早发性败血症、死亡等相比较均差异无统计学意义(P>0.05)。A组57例病人有41例接受宫颈环扎术,16例未接受宫颈环扎术,宫颈环扎术和非宫颈环扎术新生儿的孕周[(30.9±2.2)周比(28.9±1.9)周,t=3.708,P<0.001]、体质量[(1 327.32±108.71)g比(1 202.28±196.19)g,t=4.073,P<0.001]、新生儿呼吸窘迫综合征发生率(29.27%比62.50%)差异有统计学意义(χ^2=5.363,P=0.021);两组病人早产儿视网膜病变、支气管肺发育不良、脑室周围白质软化、Ⅲ度以上颅内出血、新生儿坏死性小肠结肠炎、重度窒息、早发型败血症、死亡等差异无统计学意义(P>0.05)。41例接受宫颈环扎的病人中,7例为急诊宫颈环扎,34例为择期宫颈环扎,两组新生儿呼吸窘迫综合征、早产儿视网膜病变、支气管肺发育不良、脑室周围白质软化、Ⅲ度以上颅内出血、新生儿坏死性小肠结肠炎、重度窒息、早发型败血症、死亡等发生率相比较均差异无统计学意义(P>0.05)。结论宫颈功能不全的母亲择期宫颈环扎和急诊宫颈环扎与极低出生体质量新生儿产后结局无明显相关性。

Objective To investigate the effect of cervical insufficiency and cervical cerclage on the very low birth weight new⁃borns.Methods The very low birth weight neonates born in Hainan General Hospital from January 2014 to March 2018 were se⁃lected as the research objects.According to whether the mother had cervical insufficiency,they were divided into group A(the mother had cervical insufficiency)and group B(the mother did not have cervical insufficiency).The effects of maternal cervical insufficiency and cervical cerclage on the adverse postpartum outcome of neonates were observed.Results A total of 323 very low birth weight neonates were enrolled.Among them,57 newborns in group A,accounting for 17.65%,and 266 newborns in group B,ac⁃counting for 82.35%.There were statistically significant differences in gestational weeks,premature rupture of membranes and preg⁃nancy⁃induced hypertension between group A and group B(P<0.05).There were no significant statistical differences in weight,gender,mode of delivery,neonatal distress syndrome,chorioamnionitis,pregnancy early⁃stage diabetes,antenatal hormone therapy,retinopathy of premature infants,bronchopulmonary dysplasia,periventricular leukomalacia chemical,intracranial hemorrhage above grade III,neonatal necrotizing enterocolitis,severe asphyxia,early sepsis and death(P>0.05).In group A,41 cases received cervi⁃cal cerclage,16 cases did not receive cervical cerclage,the gestational week of the neonates with cervical cerclage and non⁃cer⁃clage cerclage[(30.9±2.2)weeks vs.(28.9±1.9)weeks,t=3.708,P<0.001],body weight[(1327.32±108.71)g vs.(1202.28±196.19)g,t=4.073,P<0.001],the incidence of neonatal respiratory distress syndrome(29.27%vs.62.50%),the difference was statistically significant(χ^2=5.363,P=0.021);retinopathy and bronchopulmonary dysplasia of premature infants in two groups.There were no significant differences in periventricular leukomalacia,intracranial hemorrhage of degree Ⅲ or above,neonatal necro⁃tizing enterocolitis,severe asphyxia,early⁃onset sepsis and death(P>0.05).Among 41 sick children whose mothers received cervi⁃cal cerclage,7 were emergency cervical cerclage,34 were selective cervical cerclage.Between the 2 groups,there was no significant difference in neonatal respiratory distress syndrome,retinopathy of premature infants,bronchopulmonary dysplasia,periventricular leukomalacia,intracranial hemorrhage of degree Ⅲ or above,neonatal necrotizing enterocolitis,severe asphyxia,early⁃onset sepsis and death(P>0.05).Conclusion There is no significant correlation between elective cervical cerclage and emergency cervical cerclage for mothers with cervical insufficiency and the postpartum outcome of very low birth weight newborns.