经阴道宫颈环扎术后发生未足月胎膜早破危险因素的回顾性队列研究

Risk factors for preterm premature rupture of membranes after transvaginal cervical cerclage: a retrospective cohort study

目的探讨经阴道宫颈环扎术后发生未足月胎膜早破(preterm premature rupture of membranes,PPROM)的发生率及危险因素。方法本研究为回顾性队列研究。选取2021年1月至2022年1月在福建省妇幼保健院行经阴道宫颈环扎术的170例宫颈机能不全的单胎妊娠孕妇。根据宫颈环扎术后是否发生PPROM分为PPROM组(n=28)和未发生PPROM组(n=142)。采用两独立样本t检验、秩和检验、χ2检验或Fisher精确概率法比较组间一般情况、宫颈环扎术前及术后情况、妊娠并发症或合并症等,变量筛选的检验水准设为α=0.1,然后采用多因素logistic回归分析影响环扎术后发生PPROM的危险因素。结果经阴道宫颈环扎术后PPROM发生率为16.5%(28/170)。Logistic回归分析结果显示,宫颈锥切手术史(OR=11.966,95%CI:1.695~84.468)、环扎缝线材料为Mersilene RS22缝线(OR=3.318,95%CI:1.064~9.252)、环扎术后宫颈闭合线长度<2.5 cm(OR=3.486,95%CI:1.116~10.888)、术后宫颈分泌物支原体培养阳性(OR=4.856,95%CI:1.487~15.861)为环扎术后PPROM的独立危险因素(P值均<0.05)。结论经阴道宫颈环扎术后PPROM的发生率较高,对妊娠结局存在不利影响;宫颈锥切手术史、使用Mersilene RS22缝线施行宫颈环扎术、环扎术后宫颈闭合线长度<2.5 cm以及术后宫颈分泌物支原体培养阳性可能增加环扎术后PPROM的发生风险。

Objective To investigate the incidence and risk factors associated with preterm premature rupture of membranes(PPROM)following transvaginal cervical cerclage.Methods This retrospective cohort study involved 170 singleton pregnancies with cervical incompetence who underwent vaginal cervical cerclage at Fujian Maternity and Child Health Hospital from January 2021 to January 2022.Based on the onset of PPROM after cervical cerclage,the patients were divided into the PPROM group(n=28)and the non-PPROM group(n=142).Independent samples t-test,rank-sum test,Chi-square test,or Fisher's exact test were used to compare the general condition,pre-and postoperative data,pregnancy complications or comorbidities between the two groups,with a significance level atα=0.1.Multiple logistic regression analysis was conducted to identify the risk factors for PPROM after cerclage surgery.Results The overall incidence of PPROM after vaginal cervical cerclage was 16.5%(28/170).Logistic regression analysis showed that a history of cervical conization(OR=11.966,95%CI:1.695-84.468),the use of Mersilene RS22 tape as the suture material(OR=3.318,95%CI:1.064-9.252),cervical length<2.5 cm after cerclage(OR=3.486,95%CI:1.116-10.888),and Mycoplasma genitalium-positive results for cervical secretion culture after surgery(OR=4.856,95%CI:1.487-15.861)were the independent risk factors for PPROM after cervical cerclage(all P<0.05).Conclusions The incidence of PPROM following vaginal cervical cerclage is relatively high and can have unfavorable effects on pregnancy outcomes.Factors such as a history of cervical conization,the use of Mersilene RS22 tape for cerclage,cervical length<2.5 cm after cerclage,and Mycoplasma genitalium-positive results for cervical secretion culture after surgery may increase the risk of PPROM after cerclage.