| Objective:Meta-analysis is used to evaluate the efficacy of cervical pessary in the prevention of preterm birth and its influence on pregnancy and maternal outcomes to provide a clinical basis for cervical pessary to prevent premature delivery.Method:To searched PubMed,Web of Science,CNKI,WanFang Data,VIP and collected the literature on the study of cervical pessary to prevent preterm birth published from the establishment time of the date base until December 2016,According to the inclusion and exclusion criteria,we screened the literature,evaluated the quality and extracted the data on the basis of reviewing the full text.Using Stata12.0 statistical software to combine and analyze the extracted data and using the risk ratio(RR)as the combination statistic,according to the corresponding merger effect model selected from the heterogeneity test,the results of cervical pessary group and control group were statistically analyzed.The single and double fetuses were divided into single fetal subgroup and double fetal subgroup,and the sensitivity analysis was carried out by using the method of removing maximum weigh.The bias is evaluated and published using funnel charts.Result:A total of 8 clinical studies were included in the Meta-analysis,including 1830 cases in the cervical stent group and 1849 in the control group.3 Pregnancy Result:The cervical delivery rate of cervical stent group and control group in 28 weeks,32 weeks,34 weeks and 37 weeks were analyzed and the combined RR(95%CI)values were 0.78(0.46,1.31),0.92(0.67,1.28),0.74(0.49,1.13)and 0.79(0.54,1.15).The difference was not statistically significant(p>0.05).We compared the utilization rate of tocolytics and hormones,the combined RR(95%CI)values were 0.79(0.66,0.94)and 0.82(0.70,0.96).The difference was statistically significant(P<0.05).We compared the risk of premature rupture of membranes and the difference was not statistically significant(P>0.05).We performed a subgroup analysis of the literature into single fetal subgroup and double fetal subgroup,and there was no statistically significant difference in the delivery rate between the two subgroups during 28 and 34 weeks(P>0.05).4.Neonatus' Result:The results showed that the combined RR(95%CI)values of neonatal weight less than 1500g and less than 2500g were 0.88(0.64,1.21)and 0.90(0.74,1.08).The difference was not statistically significant(P>0.05).Neonatal complications include RDS,Periventricular Leuko-malacia,septicemia,necrotizing enterocolitis and retinopathy of premature infants.Merge the results and the difference was not statistically significant(P>0.05).3 articles on the average gestational gestational age were included in the cervical spine length<25mm.To further analyze the relationship between gestational weeks and neonatal result,three papers were Meta-analyzed:The combined RR(95%)values of septicemia is 0.45(0.22,0.93)and the difference was statistically significant(P<0.05);The combined RR(95%)values of RDS and Periventricular Leuko-malacia are 0.74(0.21,2.66)and 0.18(0.03,1.02),and the difference was not statistically significant(p>0.05);The neonatal results were analyzed by subgroup analysis of singleton and twins,and there was no significant difference between the two groups(P>0.05).Conclusion:Using cervical stent to prevent premature delivery can increase the average gestational weeks effectively compared with conventional treatment.Reduce the use of tocolytics and glucocorticoids can effectively reduce the morbidity of complications of the neonates born to the women whose length of the cervix is less than 25mm.Neonatal complications include RDS,Periventricular Leuko-malacia,septicemia,necrotizing enterocolitis and retinopathy of premature infants.Their morbidity was recorded and the difference was not statistically significant. |
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