Clinical Analysis Of 105 Cases Of Transvaginal Cervical Cerclage In Pregnancy

Cervical insufficiency is an important contributor to preterm birth and second trimester pregnancy loss.For women with a history of failure pregnancy, which may bring the many inevitable negative emotions, preterm birth remains the leading cause of neonatal morbidity and mortality, so it is especially important for us to reduce preterm birth and miscarriage during second or third-trimester pregnancy,which complete caused by cervical insufficiency. Objective:To discuss the effectiveness and safety of transvaginal cervical cerclage and to investigate the influencing factors through analysed the patients’ medical records of cervical insufficiency. Methods:1. To analyse retrospectively all the 105 patients’ medical records who have been treated with the method of transvaginal cervical cerclage in pregnancy in hospital of Jilin University from October 2010 to October 2015.The medical records include: age, materal history, high-risk factors, cervical conditions(relaxation of cervix/cervical dilatation and so on), cervical length, cervical dilatation,gestational age at cerclage,cervical cerclage category, gestational weeks of termination of pregnancy, the complications of cervical cerclage, perioperative infection indices( the postoperative WBC count and CRP value),maternal and perinatal outcomes.The maternal and perinatal outcomes and the related influencing factors of transvaginal cervical cerclage category were analyzed.2. The data were statistically processed by SPSS21.0 statistical software and analysed by the t test and c2 test. Results:Among the 105 patients of cervical insufficiency who have been treated with the method of transvaginal cervical cerclage in pregnancy, 75 patients performed preventive cervical cerclage,the other 30 patients performed therapeutic cervical cerclage. Among the 75 preventive cervical cerclage cases,8 cases of abortion,22 cases of preterm delivery,45 cases of term delivery,the number of live births was 67, 21 live births were transferred into NICU. Among the 30 therapeutic cervical cerclage cases, 9 cases of abortion,10 cases of preterm delivery,11 cases of term delivery,the number of live births was 21, 13 live births were transferred into NICU. 17 cases were stillbirth due to abortion, 7 of 17 cases were stillbirth with postoperative infection, 3 uterine malformation, 3 had surgery on their cervix, 2 twin pregnancy,1 intrauterine fetal death, 1 case comes from the other reason. Patients who received transvaginal cervical cerclage with a typical history of recurrent preterm birth/second trimester miscarriage was one of the main reasons. Patients in the preventive cerclage group underwent the procedure significantly earlier than those in the therapeutic cerclage group,cervical length and the numbers of premature birth/second trimester miscarriage were greater than those in the therapeutic cerclage group,apparent infection after surgery and operating time were observed more frequently in the therapeutic cerclage group than that of preventive cerclage group, there were statistical significance( P < 0.05). To analyse the related factors and pregnancy outcomes of 105 cases of transvaginal cervical cerclage in pregnancy, there were statistically significant( P < 0.05) difference about gestational weeks of termination of pregnancy,pregnancy outcomes, the live births and the condition of the fetus and newborn(birth weight/ transfer into NICU) between preventive cervical cerclage and therapeutic cervical cerclage. Gestational age at cerclage, cervical length, cervical dilatation, infection indices( the postoperative WBC count, CRP value, leucorrhea cleanliness), uterine malformation, operation of cervix were related to the success rates and prognosis of transvaginal cervical cerclage( P < 0.05). Conclusions:Transvaginal cervical cerclage during pregnancy could prolong the gestational age, improve pregnancy outcomes,ruduce preterm birth and second trimester pregnancy loss who with cervical insufficiency. The successful rates and prognosis of transvaginal cervical cerclage were related with gestational age at cerclage, cervical length, cervical dilatation, uterine malformation and operation of cervix,therefore,the people who had history of preterm birth and second trimester pregnancy could performe preventive cervical cerclage.If people who fould cervix shorten should be monitoring regularly, cervical cerclage was performed before cervical dilatation as far as possible. It is not recommended that people who received preventive cervical cerclage with uterine malformation/operation of cervix. Research shows that the emergency cervical cerclage can effectively prolong the gestational age and enhance the survival rate. No matter what kind of cervical cerclage performed, we should reduce or even avoid the risks of postoperative infection of cervical cerclage through the predictors of inflammatory makers(the postoperative WBC count/ CRP / PCT value),thereby improve success rates of cervical cerclage, to extend gestational age, improve the pregnancy outcomes and enhance the survival rates of infant.