孕14~17^(+6)周宫颈环扎术治疗宫颈长度10~20 mm双胎妊娠孕妇的回顾性研究

A retrospective Study of cervical Cerclage at 14~17^(+6) Weeks of Gestation for twin Pregnancy with a cervical Length of 10~20 mm

目的探究孕14~17^(+6)周行宫颈环扎术对宫颈长度为10~20 mm双胎妊娠孕妇妊娠结局及围生儿结局的影响。方法根据不同手术时机将2018年3月至2021年3月河南省人民医院收治的76例短宫颈双胎妊娠孕妇分为试验组(N=35)和常规组(N=41)。常规组于孕19~28周实施宫颈环扎术,试验组于孕14~17^(+6)周实施宫颈环扎术。比较两组手术相关指标、分娩方式、妊娠结局、围生儿结局及不良事件情况。结果观察组手术时间及住院时间短于常规组,孕周延长时间长于常规组,差异有统计学意义(P<0.05);试验组顺产率、孕期>34周分娩率高于常规组,差异有统计学意义(P<0.05);试验组足月分娩率较高,胎儿生长受限、晚期流产、胎儿窘迫、宫内感染发生率低于常规组,差异有统计学意义(P<0.05);两组胎儿畸形发生率对比,差异无统计学意义(P>0.05);与常规组比较,试验组转新生儿重症监护病房(NICU)及病死率较低,新生儿体重、Apgar评分较高,差异有统计学意义(P<0.05);试验组不良事件发生率(8.57%)较常规组(29.27%)低,差异有统计学意义(P<0.5)。结论宫颈长度为10~20 mm双胎妊娠孕妇于孕14~17^(+6)周实施宫颈环扎术效果显著,能优化手术情况及分娩方式,促进妊娠结局、围产儿结局改善,且能提高手术安全性。

Objective To investigate the effect of cervical cerclage at 14~17^(+6) weeks of gestation on pregnancy outcome and perinatal outcome of twin pregnancy with 10~20 mm cervical length.Methods A total of 76 pregnant women with short cervix twin pregnancy admitted to Henan Provincial People's Hospital from March 2018 to March 2021 were divided into the test group(N=35)and the routine group(N=41)according to different surgical opportunities.Cervical cerclage was performed at 19~28 weeks of gestation in the routine group,and at 14~17^(+6) weeks of gestation in the test group.The operation related indexes,delivery mode,pregnancy outcome,perinatal outcome and adverse events were compared between the two groups.Results The operation time and hospitalization time in the test group were shorter than those in the routine group,and the prolongation time of pregnancy week was longer than that in the routine group,with significant difference(P<0.05);The normal delivery rate and delivery rate of pregnancy>34 weeks in the test group were higher than those in the routine group,with a statistically significant difference(P<0.05);The full term delivery rate in the test group was higher,and the incidence of fetal growth restriction,late abortion,fetal distress and intrauterine infection in the test group was lower than that in the routine group,with a statistically significant difference(P<0.05);There was no significant difference in the incidence of fetal malformation between the two groups(P>0.05);Compared with the routine group,the test group was transferred to the neonatal intensive care unit(NICU)and had a lower mortality rate,higher neonatal weight and Apgar score,with a statistically significant difference(P<0.05);The incidence of adverse events in the test group(8.57%)was lower than that in the routine group(29.27%),with a statistically significant difference(P<0.05).Conclusion Cervical cerclage is effective for twin pregnancy with 10~20 mm cervical length at 14~17^(+6) weeks of gestation,which can optimize the operation and delivery mode,promote the improvement of pregnancy outcome and perinatal outcome,and improve the safety of operation.