摘要
目的探讨宫颈机能不全接受经阴道宫颈环扎术后孕妇妊娠结局及影响因素。方法本研究为回顾性研究。搜集2014年2月—2019年2月42例行经阴道宫颈环扎术孕妇的病例资料。根据环扎时子宫颈长度分为<2.0 cm组(16例)、≥2.0 cm组(26例);再根据环扎的手术时机,分为预防组(18例)、紧急组(24例)。分析组间孕妇的临床特征及妊娠结局,分析影响其预后的因素。符合正态分布的计量资料以xˉ±s表示、采用t检验,不符合者以M(Q1,Q3)表示、采用Mann-Whitney U秩和检验;计数资料以例数(%)表示、采用χ^(2)检验或Fisher确切概率法。结果(1)<2.0 cm组与≥2.0 cm组孕妇的环扎孕周分别为(22.0±4.2)、(18.5±4.7)周,分娩时孕周分别为(29.4±6.8)、(35.1±5.7)周,延长孕周时间分别为(7.4±6.0)、(16.6±6.0)周,足月分娩率分别为18.7%(3/16)、50.0%(13/26),胎儿存活率分别为50.0%(8/16)、84.6%(22/26),新生儿出生中位体质量分别为1300、3040 g,两组上述指标比较,差异均有统计学意义(P均<0.05);两组的手术时间、分娩出血量比较,差异均无统计学意义(P均>0.05)。(2)预防组与紧急组孕妇环扎时子宫颈长度分别为(3.1±0.5)、(1.5±0.7)cm,环扎时孕周分别为(13.1±3.2)、(22.6±3.7)周,延长孕周时间分别为(20.4±6.2)、(7.1±2.7)周、足月分娩率分别为55.5%(10/18)、25.0%(6/24),新生儿出生中位体质量分别为3175、2200 g,两组上述指标比较,差异均有统计学意义(P均<0.05);两组的手术时间、胎儿存活率、剖宫产分娩率、胎膜早破发生率、分娩出血量比较,差异均无统计学意义(P均>0.05)。结论环扎时子宫颈长度≥2.0 cm孕妇的妊娠结局明显优于<2.0 cm的孕妇;预防性宫颈环扎术较紧急环扎术可显著延长孕妇的分娩孕周、提高足月分娩率及胎儿存活率;紧急环扎术是可行的补救措施。
Objective To investigate pregnancy outcomes and influencing factors in pregnant women with cervical insufficiency who underwent transvaginal cervical cerclage.Methods This study was conducted as a retrospective study.Medical records of 42 pregnant women who underwent transvaginal cervical cerclage from February 2014 to February 2019 were collected.Based on the cervical length at the time of cerclage,the participants were divided into two groups:<2.0 cm group(16 cases)and<2.0 cm group(26 cases).Further categorization was done based on the timing of cerclage:prophylactic group(18 cases)and emergency group(24 cases).Clinical characteristics and pregnancy outcomes were analyzed,and factors affecting prognosis were examined.Normally distributed quantitative data were expressed as xˉ±s and analyzed using t-test,while non-normally distributed data were expressed as M(Q1,Q3)and analyzed using Mann-Whitney U test.Count data were presented as cases(percentage)and analyzed using χ^(2) test or Fisher's exact test.Results(1)The gestational weeks for cervical cerclage in the<2.0 cm group and≥2.0 cm group were(22.0±4.2)weeks and(18.5±4.7)weeks,respectively.The delivery gestational weeks were(29.4±6.8)weeks and(35.1±5.7)weeks,respectively.The extension of gestational weeks was(7.4±6.0)weeks and(16.6±6.0)weeks,respectively.The full-term delivery rate was 18.7%(3/16)and 50.0%(13/26),respectively.The fetal survival rate was 50.0%(8/16)and 84.6%(22/26),respectively.The median birth weight of newborns was 1300 g and 3040 g,respectively.The differences in the above indicators between the two groups were statistically significant(all P<0.05).There were no statistically significant differences in the surgical time and delivery blood loss between the two groups(all P>0.05).(2)In the prevention group and emergency group,the cervical lengths at the time of cerclage were(3.1±0.5)cm and(1.5±0.7)cm,respectively.The gestational weeks at the time of cerclage were(13.1±3.2)weeks and(22.6±3.7)weeks,respectively.The extension of gestational weeks was(20.4±6.2)weeks and(7.1±2.7)weeks,respectively.The full-term delivery rates were 55.5%(10/18)and 25.0%(6/24),respectively.The median birth weight of newborns was 3175 g and 2200 g,respectively.The differences in the above indicators between the two groups were statistically significant(all P<0.05).There were no statistically significant differences in the surgical time,fetal survival rate,cesarean section delivery rate,premature rupture of membranes rate,and blood loss during delivery between the two groups(all P>0.05).Conclusion Pregnant women with a cervical length≥2.0 cm had significantly better pregnancy outcomes compared to those with a cervical length<2.0 cm.Prophylactic cervical cerclage significantly prolonged the gestational week at delivery,increased the rate of full-term delivery and fetal survival rate.Emergency cervical cerclage is a feasible remedial measure.
作者
原亚莉
蒋国庆
刘亚君
刘浩
李艳芳
路军丽
YUAN Yali;JIANG Guoqing;LIU Yajun;LIU Hao;LI Yanfang;LU Junli(Department of Gynecology,the First Hospital of Tsinghua University,Beijing 100016,China;Department of Obstetrics,Beijing Chao-Yang Hospital,Capital Medical University,Beijing 100020,China;Beijing Chao-Yang Hospital,Capital Medical University)
出处
《中国研究型医院》
2023年第5期67-71,共5页
Chinese Research Hospitals
关键词
环扎术
宫颈
宫颈机能不全
子宫颈长度
Cerclage,cervical
Uterine cervical incompetence
Cervical length
