宫颈功能不全患者宫颈环扎术后妊娠结局的影响因素分析

Influencing Factors of Pregnancy Outcomes After Cervical Cerclage in Patients with Cervical Insufficiency

目的分析宫颈功能不全(CI)患者宫颈环扎术后妊娠结局的影响因素。方法选取2018年6月至2020年12月中国人民解放军联勤保障部队第九八八医院收治的105例接受宫颈环扎术的CI患者,根据术后妊娠结局分为妊娠成功组(90例)、妊娠失败组(15例),采用单因素和多因素logistic回归分析影响妊娠结局的相关因素,建立预测模型分析预测价值。结果105例接受宫颈环扎术的CI患者妊娠成功率85.71%;logistic回归分析结果显示,年龄≥35岁(OR=2.237)、宫颈管长度<2.5 cm(OR=3.700)、环扎孕周18~28周(OR=3.123)、治疗性环扎(OR=3.614)、经阴道宫颈环扎术(OR=3.191)、有生殖道感染(OR=3.172)、有环扎术前侵入性操作(OR=2.722)是CI患者宫颈环扎术后妊娠失败的危险因素,延长孕周≥15周(OR=2.701)、血红蛋白水平≥113 g·L^(-1)(OR=3.149)是CI患者宫颈环扎术后妊娠失败的保护因素(P<0.05);预测CI患者宫颈环扎术后妊娠失败的敏感度为0.867,特异度为0.922。结论CI患者宫颈环扎术后妊娠失败受年龄、宫颈管长度、环扎孕周、手术时机、手术方式等多种因素影响,以此为临床参考对患者进行综合评估、针对性干预,对改善妊娠结局具有积极意义。

Objective To analyze the influencing factors of pregnancy outcomes in patients with cervical insufficiency(CI)after cervical cerclage.Methods A total of 105 CI patients who underwent cervical cerclage in 988 Hospital of the Joint Logistics Support Force of the Chinese People’s Liberation Army from June 2018 to December 2020 were selected and divided into pregnancy success group(90 cases)and pregnancy failure group(15 cases)according to postoperative pregnancy outcomes.Univariate and multivariate logistic regression were used to analyze the related factors affecting pregnancy outcome,and a predictive model was established to analyze the predictive value.Results The pregnancy success rate of 105 CI patients who underwent cervical cerclage was 85.71%.Logistic regression analysis showed that age≥35 years(OR=2.237),cervical canal length<2.5 cm(OR=3.700),cerclage gestational week 18-28 weeks(OR=3.123),therapeutic cerclage(OR=3.614),transvaginal cervical cerclage(OR=3.191),having reproductive tract infection(OR=3.172),having invasive operation before cerclage(OR=2.722)were risk factors for pregnancy failure after cervical cerclage in CI patients,and prolonged gestational age≥15 weeks(OR=2.701)and hemoglobin level≥113 g·L^(-1)(OR=3.149)were protective factors for pregnancy failure after cervical cerclage in CI patients(P<0.05).The sensitivity and specificity of predicting pregnancy failure after cervical cerclage were 0.867 and 0.922,respectively.Conclusion Pregnancy failure after cervical cerclage in patients with CI is affected by various factors such as age,cervical canal length,gestational age of cerclage,operation timing and operation method.Taking this as a clinical reference,comprehensive evaluation and targeted intervention on patients have a positive significance in improving pregnancy outcomes.