Evaluation Of Pregnancy Outcome After Cervical Cerclage By Transvaginal Ultrasound Combined With Risk Factors

Objective To explore the influence of transvaginal ultrasound indicators,related risk factors of preterm delivery,cervical cerclage operation indication and different operation timing on pregnancy outcome after cervical cerclage.The combination of ultrasound indicators and high-risk factors of pregnant women to establish a Logistic model to improve the clinical predictability of pregnancy outcome after cerclage and provide important information for clinical prediction of preterm birth.Methods The clinical data of 91 pregnant women who underwent transvaginal cervical cerclage were retrospectively analyzed.Spearman rank correlation analysis was used to evaluate the correlation between each ultrasound indicators and the gestational age.Thegeneral characteristics or risk factors of pregnant women,different indications of cervical cerclage and timing of surgery for cervical cerclage were analyzed by single factor analysis.The Logistic regression model was established by combining the ultrasound indicators with the high risk factors of pregnant women.The diagnostic efficiency of predicting the preterm delivery was elaborated and evaluated by Norman charts,ROC curves and model calibration charts.Results 1.Cervical length,Anterior stitch depth(stitch to cannal),the cervical length below the cerclage,the cervical length above the cerclage,the cervical funnel and gestational age were positively correlated(r = 0.263,0.235,0.228,0.244,0.011,all P<0.05),the anterior uterine cervix angle was negatively correlated with the gestational age(r =-0.304,P<0.05),however,the correlation between the above ultrasound indicators and the gestational age is generally weaker.2.Multivariate analysis showed that the posterior width at level of stitch is a protective factor for delivery less than 28 weeks.Cervical length,Anterior uterocervical angle,the cervical length above the cerclage,the cervical length below the cerclage,the posterior width at level of stitch and cervical funnel do not increase the risk of preterm delivery less than 28 weeks/ 36 weeks.3.Different surgical indications and timing of operation had little effect on preterm delivery after cervical cerclage.Weight gain during pregnancy is related to delivery less than 28 weeks/ 32 weeks/ 36 weeks(p<0.05);BMI before pregnancy is related to delivery less than 28 weeks(p<0.05);the history of previous cervical cerclage is related to delivery less than 36 weeks(p<0.05).4.In the analysis of the efficiency of the preterm model,the area under the ROC curve of prediction model of delivery less than 28 weeks/32 weeks/36 weeks was 0.762,0.794,and 0.702,respectively.In the analysis of the fit of prediction model,the fit of prediction model for delivery less than 32 weeks and 36 weeks are high(p>0.05),indicating that the accuracy of the model was higher,however,the fit of prediction model for delivery less than 28 weeks is not good(P<0.05),indicating that the accuracy of the model is not high.Conclusion The cervical indicators obtained by transvaginal ultrasound has a certain clinical value in predicting premature delivery after cervical cerclage.Cervical length,the posterior width at level of stitch,the cervical length above the cerclage and the anterior uterine cervix angle are related to preterm delivery less than 28 weeks after cervical cerclage.Cervical length,Anterior stitch depth(stitch to cannal),the cervical length below the cerclage,the cervical length above the cerclage,the cervical funnel and Sludg are related to preterm delivery less than 32 weeks after cervical cerclage.Cervical length,Anterior stitch depth(stitch to cannal),the cervical length below the cerclage and the cervical length above the cerclage are related to preterm delivery less than 36 weeks after cervical cerclage.Preterm birth prediction model established by pregnant weight gain during pregnancy after cervical cerclage and mid pregnancy ultrasound indicators can improve the diagnostic efficiency of predicting preterm delivery after cervical cerclage.