McDonald宫颈环扎术在双胎与单胎妊娠合并宫颈机能不全患者中的应用

Application of McDonald's cervical cerclage in twin and singleton pregnancy complicated with cervical insufficiency

目的对比双胎与单胎妊娠合并宫颈机能不全患者应用McDonald宫颈环扎术的效果及安全性。方法选取2019年3月至2022年1月在西北妇女儿童医院产科治疗的双胎与单胎妊娠合并宫颈机能不全患者各60例为研究对象,分别设为研究组与对照组。两组患者均接受McDonald宫颈环扎术。分娩后,比较两组患者的终止妊娠孕周、延长妊娠孕周、妊娠结局(包括流产率、早产率、新生儿体质量、新生儿存活率、5 min新生儿Apgar评分)及安全性。结果研究组患者的终止妊娠与延长妊娠孕周分别为(36.63±1.76)周、(18.48±1.90)周,明显短于对照组的(38.44±1.84)周、(21.51±1.85)周,差异均有统计学意义(P<0.05);研究组患者的流产率、早产率分别为16.67%、26.67%,明显高于对照组的3.33%、11.67%,新生儿体质量、新生儿存活率、新生儿Apgar评分分别为(2.98±0.76)kg、85.00%、(7.67±0.41)分,明显低于对照组的(3.68±0.64)kg、98.33%、(9.13±0.46)分,差异均有统计学意义(P<0.05);所有患者经检查基本生命体征、肝肾功能及血、尿、便常规在正常范围内,且均未发生胎膜早破、感染、宫缩不能抑制引发流产等并发症。结论McDonald宫颈环扎术在双胎合并宫颈机能不全患者中的应用效果明显优于单胎妊娠合并宫颈机能不全患者,临床中需按照患者实际状况,给予McDonald宫颈环扎术。

Objective To compare the efficacy and safety of McDonald's cervical cerclage in twin and singleton pregnancy complicated with cervical insufficiency.Methods A total of 60 patients with twin pregnancy and singleton pregnancy complicated with cervical insufficiency in Department of Obstetrics,Northwest Women and Children's Hospital from March 2019 to January 2022 were selected as the research objects,and they were set as the study group and the control group.Both groups underwent McDonald's cervical cerclage.After delivery,the gestational weeks of termination of pregnancy,prolonged gestational weeks of pregnancy,pregnancy outcomes(including miscarriage rate,premature birth rate,neonatal weight,neonatal survival rate,5-min neonatal Apgar score),and safety were compared between the two groups.Results The gestational weeks of termination of pregnancy and prolongation of pregnancy in the study group were(36.63±1.76)weeks and(18.48±1.90)weeks,which were significantly shorter than(38.44±1.84)weeks and(21.51±1.85)weeks in the control group(P<0.05).The rates of miscarriage and preterm birth in the study group were 16.67%and 26.67%,which were significantly higher than 3.33%and 11.67%in the control group;neonatal weight,neonatal survival rate,neonatal Apgar score were(2.98±0.76)kg,85.00%,and(7.67±0.41)points,which were significantly lower than(3.68±0.64)kg,98.33%,and(9.13±0.46)points of the control group;the differences were statistically significant(P<0.05).The basic vital signs,liver and kidney functions,blood,urine,and stool routine of all patients were within the normal range,and no complications such as premature rupture of membranes,infection,and abortion due to failure to restrain uterine contraction occurred.Conclusion McDonald's cervical cerclage has better effects in patients with twin pregnancy complicated with cervical insufficiency than in patients with single pregnancy complicated with cervical insufficiency,which should be performed according to the actual situation of patients in clinical practice.