Effectiveness of Prophylactic Transvaginal Cervical Cerclage in Improving Clinical Outcomes among Pregnant Women with Cervical Insufficiency: Meta-Analysis

Background: Cervical insufficiency is one of the major causes of preterm birth among pregnant women that leads to severe mortality and morbidity issues among newborns. Prophylactic cervical cerclage is a surgical procedure performed between 11 and 14 weeks of gestation upon diagnosis of cervix insufficiency among pregnant women. Aims & Objectives: In this study, we aimed to evaluate the effectiveness of prophylactic cervical cerclage in comparison to other interventions to treat cervical insufficiency among pregnant women using a meta-analysis approach. Methods: We searched the three databases (Coachrane Library, PubMed, and MEDLINE) that were used for articles related to research aims by using MeSH keywords. The timeline of research was set from January 2015 to January 2024. The methodological quality assessment of included studies was performed by the Risk of Bias in Non-randomized Studies—of Interventions (ROBINS-I). A recent meta-analysis was conducted by using Review Manager 5.4.0 software. Results: About 441 research articles were extracted from three electronic databases and only 125 articles were assessed for eligibility criteria. Finally, 8 studies were included in the analysis for a recent meta-analysis. Six out of eight included retrospective or pilot studies were graded as having a moderate risk of bias, and two studies had low risk on the basis of owning bias. About 1008 pregnant women with cervical insufficiency were analyzed in a recent meta-analysis. By pooled analysis, it was evaluated that significant difference found in prolongation of delivery weeks (Mean difference = 1.05;Cl: 0.81 to 1.29: p > 0.00001), number of deliveries > 37 weeks (OR = 0.59;Cl: 0.19 to 1.84: p > 0.006), and preterm birth (OR = 0.73;Cl: 0.42 to 1.28: p > 0.50) among pregnant women receiving prophylactic cervical cerclage as compared to other treatment strategies. Conclusion: Recent meta-analysis suggested the prophylactic cervical cerclage reduces the rates of preterm birth, abortion rates, number of deliveries > 37 weeks, and other complications as compared to the other cervical cerclage types and conservative treatments.

Previable Premature Rupture of Membranes in Dichorionic Diamniotic Twin Gestation, Loss of Leading Twin, Emergency Cervical Cerclage and Ceaserean Delivery at Term

Introduction: Multiple pregnancies have a higher risk of premature delivery and a weakened cervix has been associated with it. In most cases, emergency cerclage has proved to be beneficial as the birth of the first twin is usually followed by the unavoidable delivery of the second twin and most fetus dies shortly after delivery. Studies have noted that delayed delivery of the second fetus in a twin pregnancy is an effective management choice and the use of cervical cerclage after the first delivery is associated with a longer inter-delivery interval. We present a case of previable premature rupture of membrane of a dichorionic diamniotic twin gestation leading to the loss of the leading twin and subsequently having emergency cervical cerclage for the second twin and caesarean delivery at term. Case Presentation: She was a case of a 29 years old, G6P1+4 with 1 living child at a gestational age of 17 weeks plus 5 days who initially was diagnosed with dichorionic diamniotic twin gestation following an early ultrasound but presented with a history of bleeding and passage of liquor per vaginam. Ultrasound done on admission showed cervical funneling and a stable state of the second twin. She subsequently had emergency cervical cerclage after stabilization on account of previable premature rupture of membrane of a dichorionic diamniotic twin gestation with the loss of the leading twin. A repeat ultrasound done prior to discharge showed closed cervical os and a good state of the fetus. She then had elective caesarean delivery at term with a good feto-maternal outcome. Conclusion: Emergency cervical cerclage should be part of the options of management after stabilization in cases of previable premature rupture of membrane in a dichorionic or multichoronic gestation so as to save the viable once.

Pregnancy Outcomes Following Transvaginal Cerclage for Cervical Insufficiency：Results From a Single-center Retrospective Study

To study maternal and perinatal outcomes after cervical cerclage in both singleton and twin pregnancies,we retrospectively reviewed women undergoing cervical cerclage for cervical insufficiency at Tongji Hospital,Wuhan,China from January 1,2010 to July 31,2015 to evaluate primary and secondary outcomes for subgroups with cervical length（CL） ≤15,〉15 to 〈25,and ≥25 mm.Of 166 patients who underwent cervical cerclage,after exclusion of patients with missed abortion and continuing pregnancy,141 patients（121 singleton and 20 twin pregnancies） were included in the analysis.Mean gestational age at birth was 34.22 and 28.27 weeks for singleton and twin pregnancies,respectively.There were 17（14.05%） and 13（33.33%） neonatal deaths in singleton and twin pregnancies,respectively.Mean age（31.60±4.62 vs.31.22±4.63 years,P=0.39） and gestational weeks at cerclage（18.50±4.62 vs.19.31±4.99,P=0.47） were similar for both groups.Mean gestational weeks at delivery（34.22±5.77 vs.28.27±6.17,P〈0.001） and the suture to delivery interval（15.72±7.15 vs.8.96±6.70,P〈0.001） were significantly longer in the singleton group.These variables indicate a linear negative correlation with the degree of CL shortening,with better outcomes in patients with CL ≥25 mm who underwent cerclage,both in singleton and twin pregnancies.No difference in mode of delivery existed between the singleton group and twin group.Our results indicate a high risk of preterm delivery in both groups,especially in the twin group.Patients with a history of preterm labor and CL 〉25 mm in the current pregnancy,possibly in a twin pregnancy,could benefit from elective cervical cerclage;however,cervical cerclage was inadvisable for twin pregnancies with a CL 〉15 and 〈25 mm.Our data emphasize the importance of re-evaluating the efficacy of cervical cerclage for twin pregnancies in well-designed clinical trials.

Removal of laparoscopic cerclage stitches via laparotomy and rivanol-induced labour: A case report and literature review

BACKGROUND Laparoscopic cervical cerclage is performed for patients with abnormal cervical anatomy and/or transvaginal cervical cerclage failure.However,the method of removing the stitches to allow labour induction remains controversial.According to published literature,stitches are removed through laparoscopic or transvaginal methods.Herein,we report,for the first time,a case of a patient who had undergone laparoscopic cerclage,and then underwent removal of stitches by laparotomy and labour induction in the third trimester of pregnancy.CASE SUMMARY A patient who underwent laparoscopic cervical cerclage due to cervical insufficiency became pregnant naturally following the operation.At 31 wk of pregnancy,severe foetal malformations were found.To successfully induce labour,cerclage stitches were removed via laparotomy,and rivanol was injected directly into the uterus.Following successful induction of labour,the patient delivered a dead foetus.CONCLUSION This report provides a reliable scheme of removing cerclage stitches for patients who have undergone laparoscopic cerclage but experience severe foetal malformations.

Prophylactic Cervical Cerclage versus Vaginal Progesterone in Triplet Pregnancy—A Randomized Prospective Comparative Study

Objective: To compare the effect of prophylactic cervical cerclage with vaginal progesterone in triplet (with normal cervical measurements) to evaluate its efficacy in improving pregnancy outcome and prolonging gestation. Design: A randomized prospective comparative study. Setting: At Tanta university hospitals and outpatient clinics. Patients: 51 selected cases of triplet pregnancy were recruited and classified into 2 groups randomly, progesterone group (n = 28 cases) and cerclage group (n = 23 cases). Interventions: Transvaginal ultrasound was done for number of fetuses, viability, cervical measurements, vaginal progesterone for progesterone starting at 20 weeks, and applying McDonald cerclage at 14 - 16 weeks for cerclage group. Main Outcome Measures: Time of occurrence of preterm labor, premature rupture of membranes (PROM), stitch removal, gestational age at delivery, mode of delivery, and neonatal complications. Results: Preterm labor occurred in 9, 8 cases and PROM in 4, and 3 cases in progesterone and cerclage groups respectively. The mean gestational age was 33.57 ± 2.97 and 31.74 ± 3.21 weeks in progesterone and cerclage groups;mean birth weight was 2049 ± 591 gm, and 1686 ± 512 gm in progesterone and cerclage groups respectively;Apgar score 7 or more was found in 52 (60.8%), and 39 (56.3%) newborn in progesterone and cerclage group respectively. Perinatal mortality was lower in progesterone group 26.1% (3 IUFD+19 neonatal) than in cerclage group 30.4% (2 IUFD + 19 neonatal). Respiratory distress syndrome (RDS) occurred in 43.9%, 49.76%, while need of mechanical ventilation occurred in 12.2%, 16.41% of progesterone and cerclage groups respectively and neonatal jaundice was found in 49.38%, 53.7% of progesterone and cerclage groups respectively. Conclusion: Vaginal progesterone seems to be more effective than prophylactic cerclage in reducing preterm delivery in triplet pregnancies with normal cervical measurements even in those with prior history of preterm labour and minimizing neonatal morbidity and mortality.

Physical Examination Indicated Rescue Cerclage to Improve Live Birth Rate at Hung Vuong Hospital in Vietnam

Emergency cerclage with advanced cervical dilatation and bulging of fetal membranes is still challenging to obstetricians.?Objective:?To identify the live birth rate after physical examination indicated rescue cerclage. Methods:?A retrospective cohort study of 36 pregnant women, who underwent rescue cerclage at Hung Vuong hospital from January 2015 to January 2019. Selection criteria: cervical dilation 10 to 40 mm, at 20 to 30 gestational weeks. Exclusion criteria: multiple pregnancy, birth defects, pregnancy termination due to maternal or fetal indications. Results: Delivery of live infant rate was 72.22%;mean pregnancy prolongation was 42.8 ±?34.15 days. Early live birth rate was 77.78%. The percentage of delivery after 34 and 37 weeks was 44.45% and 27.78%, respectively. Live birth weight was 400 to 3600?g, with mean being 1878.06 ±?1049.04?g. No procedure-related complication was observed. Conclusions:?Rescue cerclage may be an effective and safe method in prolonging pregnancy and improving neonatal outcome in women with cervical dilation 10 to 40 mm. It should be considered as a viable option for women with a dilated cervix in 20 to 30 gestational weeks. Future controlled studies are needed.

Pregnancy outcome following emergency cervical cerclage

The pregnancy outcome following emergency cervical cerclage for cervical dilatation is unclear. The case notes of pregnant women who underwent the procedure from January 1996 until December 2005 at Hull Royal Infirmary and Castle Hill Hospitals was analysed. This procedure prolonged pregnancy in all patients with the mean duration of 24 days. There were 10 live births and two still births. Among the 10 live births there were five neonatal deaths (perinatal mortality 583/1000). Neonatal outcome was universally poor if the initial cervical dilatation was more than 5 cm. All patients should be informed of the survival rates before undergoing this procedure.

Clinical Analysis on the Effectiveness of Transvaginal Cervical Cerclage in Singleton Pregnancies and Its Predictive Factors

Objective: To evaluate the effectiveness of transvaginal cervical cerclage in singleton pregnancies with cervical incompetence, determine the predictive factors of success and failure, and then compare elective and emergency cerclage. Study Design: This was a retrospective study of 62 patients who underwent cervical cerclage in The First Hospital of Jilin University, China, between May 2015 and January 2018. Successful group was defined as those who delivered live babies and failure group who experienced abortion or stillbirth. Results: Out of 104 patients, 62 met inclusion criteria. In 62 cases, 47 (75.8%) succeeded and 15 (24.2%) failed. In successful group, 21 (44.7%) women delivered pretermly and 26 (55.3%) termly. No severe complications occurred except cervical laceration (2, 3.23%), premature rupture of membranes (13, 20.97%). In 62 cases, 40 (64.5%) have ≤2 previous second-trimester losses and 22 (35.5%) have >2 previous second-trimester losses. No significant differences were found in neonatal outcomes. Analysis revealed that higher postoperative C-reactive protein and presence of premature rupture of membranes were the strongest predictors of cerclage failure. Among 62 cases, 48 (77.4%) were allocated in elective and 14 (22.6%) in emergency cerclage. Pregnancy prolongation was significantly more (P = 0.014) in elective group with no significant differences in premature rupture of membranes, neonatal outcomes (all P > 0.05) except Apgar score at 5 min (P = 0.042). Conclusion: Achieving 75.8% live births proves that transvaginal cervical cerclage is an effective and safe technique in prolonging the gestational age, improving the obstetric outcomes in singleton pregnancies with cervical incompetence under various cerclage indications. Postoperative C-reactive protein and premature rupture of membranes are the predictive factors related to success or failure. Elective cerclage is more effective in prolonging the pregnancy compared to emergency cerclage, no significant differences are seen regarding neonatal outcomes and complications.

An Innovative Cerclage Wire Passer

The cerclage wire is an important adjuvant in the management of Orthopaedic and trauma cases and is particularly useful in long bone fractures. It is especially useful for addressing the fractures, especially the comminuted ones with a butterfly fragment. Orthopaedic cerclage Wiring is used as an adjunct to maintain fracture reduction (either temporarily or permanently), while the bone is primarily stabilised by either a plate intramedullary nail or external fixation frame. Multiple cerclage wires provide adjunctive fixation against compressive shear, bending & rotational forces and have been used in traumatology since many years. The aim of this article is to introduce a new year simple low cost instrument named as “Suyash cerclage wire passer”, with excellent outcomes without any major complications to the Orthopaedic community.

Outcomes of patients who have undergone laparoscopic abdominal cerclage:A retrospective study

Objective:This study aims to evaluate the surgical morbidity and obstetric outcomes following in-pregnancy or pre-pregnancy laparoscopic abdominal cerclage(LAC)for patients who were diagnosed with refractory cervical insufficiency or had a short cervix.Methods:A retrospective study was conducted on patients undergoing LAC between May 2017 and May 2019 at the Department of Obstetrics and Gynecology,Sir Run Run Shaw Hospital.The patients were diagnosed with refractory cervical insufficiency based upon a previous failed transvaginal cervical cerclage(TVC),or had a short cervix who were considered unsuitable for a TVC after a previous cervical procedure.All patients were followed-up after surgery with transperineal ultrasonography until May 2020.Subsequently,surgical and obstetric data were collected and analyzed.Results:In total,44 patients underwent LAC,with 8 patients in-pregnancy and 36 pre-pregnancy.For the patient with pre-pregancy LAC,the pregnancy rate was 80.6%(29/36),including 3 patients with first-trimester loss,1 patient with an ectopic pregnancy,and 25 patients with a delivery.For the remaining 7 patients,3 did not conceive,and another 4 had no pregnancy plans.All the patients with in-pregnancy LAC had a delivery.The“take-home baby”rate was 89.2%(33/37),with a live-birth rate of 100%and a neonatal survival rate of 100%for both patients with in-pregnancy and pre-pregnancy LAC.For patients with in-pregnancy LAC,75.0%(6/8)patients delivered at≥37 wk of gestation,12.5%(1/8)delivered between 34 and 36^(+6)wk,and 12.5%(1/8)delivered between 28 and 33^(+6)wk.For patients with pre-pregnancy LAC,80.0%(20/25)patients delivered at≥37 wk of gestation,16.0%(4/25)delivered between 34 and 36^(+6)wk,and 4.0%(1/25)delivered between 28 and 33^(+6)wk.No adverse-event intra-operative or post-operative sequelae were noted.Conclusions:LAC is an effective and safe procedure that results in remarkable obstetric outcomes for women with refractory cervical insufficiency,or with a short cervix who are considered unsuitable for a TVC.The success rate of in-pregnancy or pre-pregnancy LAC depends on a full evaluation of patients,a proper peri-operative management and close follow-up.

Successful delivery of unicornuate uterus pregnancy after laparoscopic cervical cerclage: A case report

There are few reports of the successful delivery of unicornuate uterus pregnancy after laparoscopic cervical cerclage.Here,we report a 32-year-old woman,gravida 2 para 1,who had been admitted for unicornuate uterus pregnancy by a thawed frozen blastocyst transplantation.She accepted laparoscopic cervical cerclage for cervical insufficiency and delivered successfully via caesarean section at 35^(+3) weeks.Cervical cerclage may be used as an effective method of preventing abortion in unicornuate uterus pregnancy,while surgery by laparoscopy would be a better choice for patients with poor cervical condition.Obstetricians should pay due attention to complications such as uterine rupture for these highrisk patients.

Laparoscopic Transabdominal Cerclage

Cervical insufficiency is seen in 0.1% - 1% of all pregnancies and classical treatment involves vaginal cerclage. In some conditions, such as an extremely short, deformed or absent cervix, surgery needs to be done by transabdominal approach. We use a simplified technique for laparoscopic transabdominal cerclage compared to the technique described in previous studies. Furthermore, we give a review on the literature published on this subject. We have a case series of 12 patients operated in a non-pregnant state with previously failed vaginal cerclage (n = 4) or in which a vaginal approach appeared to be impossible due to a history of cervical surgery (n = 8). Minor complication of vaginal erosion of the cerclage tape was described in 2 cases. Comparable studies of transabdominal cerclage via laparotomy or laparoscopy could not show any difference in obstetric outcome. Several studies mentioned the advantages of the laparoscopic approach (short hospitalisation, fast recovery, high placement of the suture,) and no complications were described. Transabdominal cerclage performed by laparoscopy seems to be a feasible technique in cases transvaginal cerclage fails or is technically impossible.

因宫颈机能不全行孕期经阴道宫颈环扎术孕妇妊娠结局影响因素分析

目的:探讨因宫颈机能不全行孕期经阴道宫颈环扎术(TVC)的孕妇妊娠结局的影响因素。方法:选择2016年1月至2022年12月郑州大学第一附属医院收治的328例因宫颈机能不全行孕期TVC的孕妇,以分娩孕周≥28周且新生儿存活为成功标准,260例成功,68例失败。采用Logistic回归分析筛选TVC妊娠结局的影响因素。结果:Logistic回归分析结果显示,年龄、既往孕中期自然流产和(或)早产次数、辅助生殖助孕史、术后并发症是TVC孕妇妊娠结局的影响因素,OR(95%CI)分别为1.110(1.040~1.185)、1.519(1.027~2.248)、0.436(0.214~0.891)和4.711(1.544~14.372)。结论:年龄、既往孕中期自然流产和(或)早产次数、辅助生殖助孕史、术后并发症是单胎孕期TVC疗效的影响因素。

预防性McDonald术对宫颈纵隔切开术后宫颈机能不全的治疗效果

目的:探讨预防性宫颈环扎术对宫颈纵隔切开术后宫颈机能不全(CIC)的治疗效果。方法:收集2012年9月至2022年12月在郑州大学第一附属医院行预防性McDonald术的宫颈纵隔切开术后CIC的患者共20例(纵隔组),均为单胎妊娠。从同时间段在该院行预防性McDonald术的非子宫畸形单胎妊娠的CIC患者中,采用倾向性评分匹配法(最近邻匹配法,1∶1匹配)选取20例(非畸形组)。比较两组的疗效,包括妊娠结局、分娩方式及新生儿情况等。结果:两组基线资料差异无统计学意义。纵隔组和非畸形组的活产率分别为15/20和18/20,低出生体重儿率分别为6/15和5/18,差异均无统计学意义(P>0.05)。纵隔组的足月产率(25%)低于非畸形组(60%,P<0.05)。结论:预防性McDonald术对宫颈纵隔切开术后CIC患者是可行的,宫颈纵隔切开术后和非子宫畸形的CIC患者预防性McDonald术的疗效无明显差异。

宫颈环扎术治疗三胎妊娠合并宫颈机能不全二例

三胎妊娠围产期并发症和合并症较单胎和双胎妊娠明显升高,其中最值得关注的是早产和早产儿发病及死亡,如果三胎妊娠合并宫颈机能不全则流产或早产的风险更高。报道2例通过辅助生殖技术受孕的三胎妊娠(双绒毛膜三羊膜囊)合并宫颈机能不全患者,1例孕前行腹腔镜宫颈环扎术,另1例在孕15+5周行经阴道宫颈环扎术,孕期均定期产检阴道超声监测宫颈长度并及时治疗预防早产,分别在孕33+2周和孕33+3周成功剖宫产分娩三活婴。对于不愿意采用减胎术的三胎妊娠合并宫颈机能不全患者,宫颈环扎术是一个可靠的治疗方案,定期随访对防治早产、指导临床用药及适时拆除宫颈环扎线并改善母儿预后至关重要。

阴道宫颈环扎术对双胎妊娠宫颈机能不全患者疗效及妊娠结局的影响

目的 分析阴道宫颈环扎术对双胎妊娠宫颈机能不全患者疗效及妊娠结局的影响。方法 选取90例使用辅助生殖技术(ART)的双胎妊娠宫颈机能不全患者,将患者出生日期作为分组基础,应用随机数字分组模式分为观察组和对照组,每组45例。对照组采用传统保胎治疗模式干预,观察组采用阴道宫颈环扎术治疗模式干预。对比两组分娩孕周、实际延长时间、新生儿出生体质量、新生儿Apgar评分、新生儿不良预后情况及不良妊娠结局发生率。结果 对照组分娩孕周为(34.09±2.17)周,实际延长时间为(36.47±3.71)d;观察组分娩孕周为(37.50±1.93)周,实际延长时间为(39.12±2.99)d。观察组分娩孕周、实际延长时间均长于对照组(P<0.05)。对照组新生儿出生体质量为(2231.61±361.60)g,新生儿Apgar评分为(7.91±0.62)分;观察组新生儿出生体质量为(2921.59±861.22)g,新生儿Apgar评分为(8.94±0.84)分。观察组新生儿出生体质量、新生儿Apgar评分大于对照组(P<0.05)。对照组新生儿出现呼吸窘迫综合征7例、缺氧缺血性脑病4例、死亡0例,观察组新生儿出现呼吸窘迫综合征1例、缺氧缺血性脑病0例、死亡0例。观察组新生儿不良预后发生率1.11%低于对照组的12.22%(P<0.05)。两组不良妊娠结局发生率比较无明显差异(P>0.05)。结论 在对ART的双胎妊娠宫颈机能不全患者治疗过程中,灵活地将阴道宫颈环扎术应用于实际治疗中,能够取得更为确切的治疗效果,在保障患者自身安全及预后的情况下,最大程度地改善新生儿的状态,可在今后的治疗中将此类方式推广并加以应用,进而保障患者健康。

子宫血管缝扎术及宫颈环状缝扎术联合双侧髂内动脉球囊阻断治疗PPP合并胎盘植入效果

目的:探讨凶险性前置胎盘(PPP)合并胎盘植入治疗效果。方法:选取2019年3月-2023年5月本院就诊治疗的PPP合并胎盘植入患者56例临床资料,根据治疗方式不同分为两组,采用子宫血管缝扎术及宫颈环状缝扎术联合双侧髂内动脉球囊阻断治疗为观察组26例,采用单纯双侧髂内动脉球囊阻断治疗为对照组30例,分析两组相关指标。结果:治疗后两组甲胎蛋白及绒毛膜促性腺激素水平均较术前降低,且观察组(82.6±26.3 ng/ml、122.3±56.3 mIU/ml)低于对照组(113.0±41.1 ng/ml、649.5±86.5 mIU/ml),总并发症发生率观察组(3.8%)低于对照组(23.3%)(均P<0.05);两组新生儿Apgar评分(9.6±0.3分、9.3±0.6分)无差异(P>0.05)。观察组住院时间(6.6±1.2d)及住院费用(3.2±0.6)万元均低于对照组(7.9±1.5d)(4.3±1.0)万元(P<0.05)结论:采取子宫血管缝扎与宫颈环状缝扎术、双侧髂内动脉球囊阻断治疗PPP合并胎盘植入可效果更佳,且可降低术后并发症,术后恢复更快,对新生儿未产生不良影响。

经会阴超声测量宫颈长度及宫颈前角对孕期经阴道宫颈环扎术后早产的预测价值

目的:探讨经会阴超声测量宫颈长度(CL)及宫颈前角(ACA)对孕期经阴道宫颈环扎术后早产的预测价值。方法:收集2021年1月至2022年6月在郑州大学第一附属医院诊断为宫颈机能不全而行经阴道宫颈环扎术的单胎妊娠孕妇189例,环扎术前24 h内行经会阴超声检查,测量CL及ACA。以CL和ACA为自变量,以是否早产为因变量,进行Logistic回归,构建联合预测模型。绘制ROC曲线,分析环扎术前CL、ACA及两者联合对早产的预测价值。结果:189例中,早产67例(35.4%)。早产组CL小于非早产组[27.00(15.00,34.00)mm vs 32.00(28.75,36.25)mm],ACA大于非早产组[(120.13±11.47)°vs(103.52±17.44)°](P均<0.05)。CL、ACA及两者联合预测环扎术后早产的AUC(95%CI)分别为0.679(0.596~0.762)、0.792(0.727~0.856)、0.813(0.749~0.877),ACA及CL联合ACA的AUC大于CL(P<0.05)。结论:经会阴超声测量ACA可辅助CL预测孕期经阴道宫颈环扎术后早产的发生。

孕前腹腔镜子宫颈环扎术治疗子宫颈机能不全的临床疗效分析

目的:探讨孕前腹腔镜子宫颈环扎术(LCC)在改善子宫颈机能不全妊娠结局中的应用价值。方法:回顾性分析郑州大学第一附属医院2014年7月1日至2023年5月31日112例子宫颈机能不全患者行孕前LCC的临床资料。其中孕前LCC手术指征为:经阴道子宫颈环扎术(TCC)失败(42例)、子宫颈手术史+TCC失败(7例)、不适合TCC(10例)和患者强烈要求(53例)。分析孕前LCC患者的手术情况及妊娠结局,对比孕前LCC后妊娠并分娩的患者和因不同手术指征行孕前LCC患者手术前后的分娩孕周。结果:112例患者中位手术时间65.5 min、中位术中出血量10.0 ml,无术中并发症,术后住院时间2.9±0.6 d。术后随访到108例,LCC后妊娠分娩77例,术前共分娩205次,术后共分娩81次;术后成功分娩(孕周>28周)78次(96.3%),平均分娩孕周37.4±1.7周;早产率16.7%,足月产率83.3%。孕前LCC后孕周≥28周分娩率明显高于孕前LCC的既往分娩率(96.3%vs.10.7%,P<0.05),分娩孕周显著延长(36.4±5.5周vs.19.8±7.5周,P<0.05)。不同手术指征行孕前LCC的术后分娩孕周,除手术指征为不适合TCC外(P>0.05),其余均显著晚于孕前LCC既往分娩孕周(P<0.05)。结论:孕前LCC手术安全性高,可显著延长子宫颈机能不全患者的分娩孕周改善妊娠结局,可作为既往存在TCC失败史患者的有效治疗方法。

宫颈环扎术联合子宫颈托对宫颈机能不全患者临床疗效的meta分析

目的:运用meta分析的方法比较宫颈环扎术联合宫颈托与单独行宫颈环扎术在宫颈机能不全患者早产预防方面的临床疗效,为临床诊疗提供循证医学证据。方法:计算机检索知网、万方、PubMed、Web of Science、Cochrane Library数据库自建库至2023年10月1日所有相关文献,由2位研究人员根据纳入与排除标准独立地进行文献筛选、数据提取和质量评价,使用Review Manager (RevMan)(Computer program).Version 5.4.1进行数据分析,比较宫颈环扎术联合宫颈托组与单独使用宫颈环扎术组在妊娠小于34周早产、妊娠小于37周早产、妊娠小于32周早产、妊娠小于28周流产发生率及新生儿NICU入院率、新生儿出生体重、剖宫产率、延长妊娠天数等方面的差异。结果:共检出1477篇可能相关文章,通过阅读摘要、删除重复文献,最终纳入5篇文献进入meta分析。宫颈环扎术后联合使用宫颈托组与单独行宫颈环扎术组相比,在妊娠小于34周早产率(OR=0.83,95%CI为0.42~1.63,P=0.59)、妊娠小于37周早产率(OR=0.90,95%CI为0.55~1.46,P=0.66)、妊娠小于32周早产率(OR=0.52,95%CI为0.25~1.07,P=0.08)、妊娠小于28周流产率(OR=0.53,95%CI为0.21~1.32,P=0.17)、新生儿NICU入院率(OR=0.77,95%CI为0.44~1.36,P=0.37)、新生儿出生体重(MD=37.97,95%CI为-263.97~339.92,P=0.81)、剖宫产率(OR=1.22,95%CI为0.50~2.99,P=0.67)、延长妊娠天数(MD=16.09,95%CI为-8.41~40.32,P=0.19)等方面差异均无统计学意义。宫颈机能不全患者中伴有羊膜囊膨出的患者单独进行meta分析,结果显示宫颈环扎术联合宫颈托组与单独使用宫颈环扎术组在延长妊娠天数(MD=37.39,95%CI为15.98~58.79,P=0.0006)、增加新生儿出生体重(MD=722.58,95%CI为145.96~1299.20,P=0.01)、减少妊娠小于32周早产发生率(OR=0.20,95%CI为0.06~0.64,P=0.007)等方面差异均有统计学意义。结论:宫颈环扎术前伴有羊膜囊膨出的患者中,宫颈环扎术后联合使用子宫颈托与单独行宫颈环扎术相比可显著延长妊娠天数、增加新生儿出生体重、减少妊娠小于32周自发性早产发生率。但研究数量有限,研究结论有待高质量、大样本、多中心的随机对照实验进一步验证。