宫颈环扎术对单胎及双胎妊娠的宫颈机能不全患者妊娠结局的影响

Effect of cervical cerclage on pregnancy outcome in patients with cervical insufficiency in singleton and twin pregnancies

目的分析单胎及双胎妊娠的宫颈机能不全(CIC)患者经阴道行宫颈环扎术的妊娠结局,探讨不同的环扎时机对妊娠结局的影响。方法回顾性分析186例CIC患者的临床资料,根据是否经阴道行宫颈环扎术及环扎时机不同分为单胎紧急宫颈环扎组(30例)、单胎择期宫颈环扎组(120例)、单胎未行宫颈环扎组(孕24~28周存在宫口扩张,13例),双胎紧急宫颈环扎组(宫颈管长度<15 mm且宫口扩张,13例)、双胎择期宫颈环扎组(宫颈管长度<15 mm且宫口未开,10例)。比较不同环扎孕周单胎择期宫颈环扎组、单胎紧急宫颈环扎组患者的妊娠结局(术后延长孕周、分娩孕周、新生儿存活率、早产率、足月产率),孕24~28周环扎的单胎紧急宫颈环扎组与单胎未行宫颈环扎组患者的妊娠结局;双胎紧急宫颈环扎组与双胎择期宫颈环扎组患者的妊娠结局、环扎孕周。结果孕13~18^(+6)周、19~23^(+6)周、24~28周环扎的单胎择期宫颈环扎组患者的术后延长孕周分别为20.45(16.17,22.13)、15.30(12.70,19.00)、12.10(9.45,13.35)周,早产率分别为35.14%、12.00%、47.62%,比较差异有统计学意义(P<0.05)。孕13~18^(+6)周、19~23^(+6)周、24~28周环扎的单胎择期宫颈环扎组患者的分娩孕周、足月产率、新生儿存活率比较差异无统计学意义(P>0.05)。孕13~18^(+6)周、19~23^(+6)周、24~28周环扎的单胎紧急宫颈环扎组患者的术后延长孕周分别为(16.64±9.81)、(6.78±5.88)、(9.54±4.31)周,分娩孕周分别为(32.76±8.25)、(29.01±5.67)、(35.35±3.98)周,新生儿存活率分别为80.00%、36.36%、85.71%,比较差异有统计学意义(P<0.05);孕13~18^(+6)周、19~23^(+6)周、24~28周环扎的单胎紧急宫颈环扎组患者的足月产率、早产率比较差异无统计学意义(P>0.05)。与单胎未行宫颈环扎组比较,孕24~28周环扎的单胎紧急宫颈环扎组患者的术后延长孕周长,分娩孕周晚,新生儿存活率、足月产率高,早产率低,但差异均无统计学意义(P>0.05)。双胎紧急宫颈环扎组患者的术后延长孕周短于双胎择期宫颈环扎组,差异有统计学意义(P<0.05);双胎紧急宫颈环扎组与双胎择期宫颈环扎组患者的分娩孕周、环扎孕周、新生儿存活率、足月产率、早产率比较差异均无统计学意义(P>0.05)。结论对于单胎妊娠存在宫口扩张的孕妇,孕24~28周行紧急宫颈环扎术可提高新生儿存活率;有高危因素的单胎妊娠孕妇,孕13~18^(+6)周行预防性宫颈环扎术可有效改善妊娠结局;双胎妊娠宫口未开且宫颈管长度<15 mm的患者行预防性宫颈环扎术可提高新生儿存活率,改善妊娠结局。

Objective To analyze the pregnancy outcomes of cervical incompetence(CIC)patients undergoing transvaginal cervical cerclage in single and twin pregnancies,and explore the impact of different timing of cerclage on pregnancy outcomes.Methods The clinical data of 186 patients with CIC were retrospectively analyzed.According to the whether or not transvaginal cervical cerclage was done and the different timing of cervical cerclage,they were divided into group of singleton pregnancy with emergency cervical cerclage(30 cases),group of singleton pregnancy with elective cervical cerclage(120 cases),group of single pregnancy without cervical cerclage(dilatation of the uterine orifice at 24-28 weeks of gestation,13 cases),group of twin pregnancy with emergency cervical cerclage(endocervical canal length<15 mm with dialation of the uterine orifice,13 cases),group of twin pregnancy with elective cervical cerclage(endocervical canal length<15 mm with unopened uterine orifice,10 cases).Comparison was made on pregnancy outcomes(postoperative prolonged gestational weeks,gestational weeks of delivery,neonatal survival rate,preterm birth rate,and full-term birth rate)of patients in group of singleton pregnancy with elective cervical cerclage and the group of singleton pregnancy with emergency cervical cerclage with different gestational weeks of cerclage,pregnancy outcomes of patients in group of singleton pregnancy with emergency cervical cerclage and the group of singleton pregnancy without emergency cervical cerclage at 24-28 weeks of gestation,as well as the pregnancy outcomes and gestational weeks of cerclage of of patients in group of twin pregnancy with emergency cervical cerclage and the group of twin pregnancy without emergency cervical cerclage.Results The postoperative prolonged gestational weeks of patients in the group of singleton pregnancy with elective cervical cerclage who were circumcised at 13-18^(+6),19-23^(+6),and 24-28 of gestation were 20.45(16.17,22.13),15.30(12.70,19.00),and 12.10(9.45,13.35)weeks,and the preterm birth rates were 35.14%,12.00%,12.00%,and 47.62%.The difference was statistically significant(P<0.05).There was no statistically significant difference in the comparison of gestational weeks of delivery,full-term birth rate,and neonatal survival rate among patients in group of singleton pregnancy with elective cervical cerclage who were circumcised at 13-18^(+6),19-23^(+6),and 24-28 weeks of gestation(P>0.05).The postoperative prolonged gestational weeks of patients in group of singleton pregnancy with emergency cervical cerclage who were circumcised at 13-18^(+6),19-23^(+6),and 24-28 weeks of gestation were(16.64±9.81),(6.78±5.88),and(9.54±4.31)weeks,the gestational weeks of delivery were(32.76±8.25),(29.01±5.67),and(35.35±3.98)weeks,and the neonatal survival rate were 80.00%,36.36%,and 85.71%.The differences were statistically significant(P<0.05).There was no statistically significant difference in the comparison of full-term birth rate and preterm birth rate among patients in group of singleton pregnancy with emergency cervical cerclage who were circumcised at 13-18^(+6),19-23^(+6),and 24-28 weeks of gestation(P>0.05).Compared with the group of singleton pregnancy without cervical cerclage,patients in group of singleton pregnancy with emergency cervical cerclage who were circumcised at 24-28 weeks of gestation had a longer postoperative prolonged gestational weeks,a later gestational week of delivery,a higher neonatal survival rate,a higher full-term birth rate,and a lower preterm birth rate,but the differences were not statistically significant(P>0.05).The postoperative prolonged gestational weeks of patients in group of twin pregnancy with emergency cervical cerclage were shorter than those in the twin pregnancy with elective cervical cerclage,and the difference was statistically significant(P<0.05).There was no statistically significant difference between the group of twin pregnancy with emergency cervical cerclage and the twin pregnancy with elective cervical cerclage when comparing the patients'gestational weeks of delivery,gestational weeks of cerclage,neonatal survival rate,full-term birth rate,and preterm birth rate(P>0.05).Conclusion For pregnant women with dilatation of uterine orifice in single pregnancy,emergency cervical cerclage at 24-28 weeks of gestation can improve the neonatal survival rate;Prophylactic cervical cerclage at+613-18 weeks of gestation in singleton pregnancies with high-risk factors is effective in improving pregnancy outcome;Prophylactic cervical cerclage in twin pregnancy with unopened uterine orifice and cervical canal length<15 mm can improve the neonatal survival rate and pregnancy outcome.