孕中期经阴道紧急子宫颈环扎术治疗子宫颈机能不全影响妊娠结局的相关因素分析

Analysis of the Related Factors Affecting Pregnancy Outcome in the Treatment of Cervical Incompetence by Emergency Cervical Cerclage in Second Trimester

目的:探讨孕中期子宫颈机能不全的患者行经阴道紧急子宫颈环扎影响妊娠结局的相关因素。方法:回顾性分析2016年1月至2021年1月在首都医科大学附属北京妇产医院孕中期行经阴道紧急子宫颈环扎并分娩的孕妇82例的临床资料,按照环扎成功与否分为成功组(61例)和失败组(21例),成功组为足月分娩及早产,失败组为晚期流产。对孕中期影响经阴道紧急子宫颈环扎的相关因素行单因素及Logistic回归多因素分析。结果:行紧急子宫颈环扎的患者成功率为74.39%。单因素分析示:成功组与失败组的环扎孕周(22.87±2.66周vs 21.38±3.26周)、术前子宫颈长度(1.68±0.87 cm vs 0.80±0.84 cm)、宫口扩张(0.28±0.70 cm vs 2.74±1.30 cm)差异有统计学意义(P<0.05)。Logistic回归多因素分析示:术前子宫颈长度<1 cm、宫口扩张≥3 cm是导致紧急子宫颈环扎失败的危险因素(OR>1,P<0.05);而子宫颈环扎孕周≥24周是紧急子宫颈环扎失败的保护因素(OR<1,P<0.05)。结论:孕中期行紧急子宫颈环扎术是安全可行的。对高危孕妇可尽早进行超声筛查,在子宫颈长度≥1 cm、宫口扩张≤3 cm时及时进行手术,能明显降低孕晚期流产率,改善妊娠结局。

Objective:To investigate the related factors influencing the pregnancy outcome of patients with cervical incompetence received emergency cervical cerclage in second trimester.Methods:From January 2016 to January 2021,the clinical data of 82 pregnant women who underwent emergency cervical cerclage and delivered in Beijing Obstetrics and Gynecology Hospital affiliated to Capital Medical University were retrospectively analyzed.According to the success of cerclage,they were divided into success group(61 cases)and failure group(21 cases).The successful group was defined as full term and premature birth,and the failure group was defined as late abortion.Univariate analyses and Logistic regression analyses were performed on relevant factors affecting the emergency cervical cerclage in the second trimester of pregnancy.Results:The success rate of emergency cervical cerclage was 74.39%.Univariate analysis showed that there were significant differences in gestational week(22.87±2.66week vs 21.38±3.26 week),preoperative cervical length(1.68±0.87 cm vs 0.80±0.84 cm)and uterine dilation(0.28±0.70 cm vs 2.74±1.30 cm)between the successful group and the failed group(P<0.05).Logistic regression analysis showed that preoperative cervical length<1 cm and uterine dilation≥3 cm were the risk factors leading to the failure of emergency cervical cerclage(OR>1,P<0.05).However,the duration of pregnancy≥24 weeks was a protective factor for emergency cervical cerclage(OR<1,P<0.05).Conclusions:Emergency cervical cerclage in the second trimester is safe and feasible.For high-risk pregnant women,ultrasound screening can be carried out as soon as possible,and operation can be performed on time when the cervical length is≥1 cm and cervical dilation is≤3 cm,which can significantly reduce the rate of late abortion and improve the pregnancy outcome.