| Background and Objectives:Cervical insufficiency (CIC) has a history of second or early third trimester fetal loss, after painless dilatation of the cervix, prolapse or rupture of the membranes, and expulsion of a live fetus despite minimal uterine activity.CI accounts for 8%of fetal losses in the trimmest and remains a major cause of neonatal morbidity and mortality. Cervical cerclage has been demonstrated to be an effective intervention in some subgroups of women who are at particularly high risk of cervical insufficiency, the most important objective of which is to prolong gestation, reduce the occurrence rate of premature birth and late spontaneous abortion, and to help increase neonatal survival rate. Premature birth, second trimester spontaneous abortion, repeated abortion and delivery history can all lead to cervical lesions, which in turn develop to be factors of cervical insufficiency. Likewise, patients with different clinical characteristics and manifestation after cervical cerclage have various pregnancy outcomes. So we looked retrospectively at patients undergoing cervical cerclage, analyzed different pregnancy outcomes and related factors, discussed the relevance between different clinical characteristics and pregnancy outcomes, analyzed risk factors that may lead to adverse pregnancy outcomes, and aimed to provide a reference pathway to improve cervical cerclage success rates.Objects and Methods:We carried retrospective analysis and collected 97 cases of pregnant women who experienced sutures and gave birth at Qilu Hospital of Shandong University after cervical cerclage between July 2010 and July 2015, excluding 23 cases of intra-uterine death, fetal malformation, multiple gestation,ruptured membranes within 48 hours postoperative and those with incomplete clinical data. Ultimately 74 patients were included in this study.Taking the survival of the newborn as the grouping standard, neonatal survivors are grouped as "success group", newborns that don’t survive as "failure group"According to the 8th edition of Gynecology and Obstetrics and related literature about the diagnostic criteria for preterm birth, patients who labor between 28 and 36+6 weeks are called "preterm group", those after 37 weeks are "term birth group". Clinical data are extracted from Qilu Hospital’s electronic database. We collected medical history and basic information of all the pregnant women, including basic maternal age, history of induced abortion, premature birth and spontaneous abortion in second trimester, term delivery history. Complications of pregnancy, including premature rupture of membranes(PROM), gestational diabetes mellitus(GDM), assisted reproductive techniques(ART), vulvovaginal candidiasis(VVC), conization history, scarred uterus, combined with uterine myoma. Clinical data, including gestational age of cerclage, cerclage-delivery interval, gestational age at time of delivery, number of hospital admissions, length of hospital day, initial pregnancy outcomes. Auxiliary examination data, including cervical length(CL),cervical inside width, the highest level of white blood cell(WBC) count and C-reactionprotein(CRP). We researched the correlation between maternal pregnancy outcomes and relevant clinical and laboratory data, to discover the factors about pregnancy outcomes and then analyzed.We used SPSS 15.0 to analyze the data and mean and standard deviation to describe the measurement data, t-test for stastical analysis; Description of the frequency data was based on percentage(%), using the chi-square to inspect and analyze group difference. Binary Logistic regression analysis may affect the relation between risk factors of cervical cerclage and pregancy outcomes. P<O.05 indicates significant differences. ROC curve wae drawn by SPSS 15.0, to research the most appropriate diagnostic criteria for cervical insufficiency and surgical indications of cervical cerclage.Results:1.74 patients’pregnancy outcomes:63 neonatal survive (success group), average extended gestational age is 18.30 weeks,; 11 newborns do not survive(failure group), an average of 4.32 weeks are prolonged, the success rate of cerclage is 85.14%.2.Comparision of clinical states between success and failure groups:patients’age, history of induced abortion during early pregnancy, second trimester spontaneous abortion history, vaginal delivery, gestation age of cervical cerclage, and the total days of hospitalization between the two groups are not statistically significant (p>0.05). There are differences between the two groups on prolonged weeks and the number of hospital admission.(p<0.05).3.Comparision of auxiliary examination results between success and failure groups: there are no significant statistical difference on cervical inside width and WBC count (P>0.05); while the difference between cervical length and CRP in the two groups is statistically significant ((p<0.05).4. Comparison of clinical states between preterm and full-term group:the total days of hospitalization, mode of delivery between the two groups don’t show significant statistical difference (p>0.05); numbers of hospital admission time, prolongation of gestational age, and newborns’transfer rate to NICU between the two groups have significant statistical difference (p<0.05).5.Comparision of auxiliary examination results between preterm and full-term group:There are no significant differences on cervical length,cervical inside width, WBC count and CRP level (p>0.05).6.Risk factors for pregnancy outcomes:PROM and ART have considerable effect on pregnancy outcomes(p<0.05); while GDM, VVC, conization history, scarred uterus and uterine myoma have no significant effect on pregnancy outcomes.7.We divided 74 cases into 2 groups by the time of the pregnancy ending, and analyzed by ROC curve. The results show that under curve area of the spontaneous abortion times during second trimester is 0.535(p=0.538,95%credibility interval is 0.421-0.648), under curve area of cervical length is 0.594 (p=0.089,95% credibility interval is 0.570-0.617); According to the results of the Roe curve, we deduce that it is not precise to take spontaneous abortion times during second trimester and cervical length as diagnostic standard and surgical indication of cervical insufficiencyConclusions:1.Selective cervical cerclage for CIC patients can increase the effective rate of cerclage.2. If patients after cerclage have symptoms of contraction, vaginal bleeding and others go hospital again, prompt treatment and intervention can influence pregnancy outcomes.3. PROM and ART may be risk factors that can lead to adverse pregnancy outcomes.CL before cervical cerclage is a protective factor for pregnancy outcome.4.CRP levels can be taken as monitoring index after cerclage, whose continuous remarkable increase after cerclage can in most cases indicate adverse pregnancy outcomes; WBC count has little effect on pregnancy outcomes. |
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