Clinical Effect Of McDanold Combined For Cervical Incompetence

Cervical incompetence(CIC),also known as cervical laxity,usually refers to the failure of the cervix to maintain the pregnancy to the full term due to anatomical or functional defects in the absence of contraction.Cervical pain free expansion in the middle of pregnancy is one of the main causes of recurrent late abortion and premature delivery.The incidence of the CIC is up to 0.27~1.84%.Cervical cerclage is a common method for the treatment of CIC and also the best method for the treatment of cervical incompetence during pregnancy.To a certain extent,the perinatal outcome was improved.Objective 1.to evaluate the clinical results of the patients with cervical incompetence in our hospital,and to evaluate the clinical effect of McDonald cervical cerclage combined with noninvasive treatment of cervical incompetence.2.to patients with CIC,cervical mass score(see table 12)more than 10points,The influencing factors were analyzed to provide a clinical basis for further standardizing diagnosis and treatment of cervical incompetence.Methods from June 2016 to July 2017,the clinical data of patients with cervical incompetence were collected,and divided into surgical treatment group and conservative treatment group according to the treatment methods.The surgical treatment was divided into preventional and emergency encircling group.An effective group(prolonged 48 hours)and an ineffective group(prolonged less than 48 hours)were extended after the operation,and patients were divided into successful group(28 weeks of pregnancy)and failure group(less than 28 weeks of pregnancy)according to the pregnancy outcome.The general data,clinical data,clinical effects and influencing factors of pregnancy outcome in patients with cervical incompetence were compared.Results:there were 86 patients in preventional cerclage group,25 in the emergency cerclage group,and 23 in the conservative treatment group.In the three groups,89 neonates survived,accounting for 66.42%,and 45 neonates died,accounting for 33.58%.Three groups of patients were successful in 95 cases,accounting for 63.43%;failure in 39cases,accounting for 22.39%.115 cases were effective,accounting for 85.81%,and19 cases failed,accounting for 14.18%.Among the three groups,39 cases were aborted,accounting for 29.10%,71 cases of premature delivery,52.98%,and 24 cases of full-term delivery,accounting for 17.92%.1.during three groups of patients,gestational age,cervical length at admission,cervical width at admission were all P<0.05,the difference was statistically significant.The age,parity,parity and average number of abortions in the three groups were all P>0.05,the difference was not statistically significant.The degree of cervical expansion between the three groups was statistically significant(P<0.05).Three groups of patients with conception,number of pregnancies,history of preterm delivery,history of cervical conization surgery,and uterine fibroids were compared,P>0.05,the difference was not statistically significant.2.the operation time and the amount of bleeding in the emergency cerclage group and the preventive cerclage group,P<0.05,the difference was statistically significant,but the number of catheter indwelling days in the emergency cerclage group and the preventive cerclage group was compared,P>0.05,the difference was not statistically significant.The pregnancy outcomes of the three groups were compared with those of chi squareχ~2=28.430,P<0.000,the difference was statistically significant.With the success of 28 weeks gestational age,the power of preventive cerclage was the highest,and the emergency cerclage group was the second,and the conservative treatment group was the lowest.The ratio of neonatal death and survival between the three groups was statistically significant(χ~2=10.212,P<0.05),and the difference was statistically significant.The survival rate of neonates in the preventive cerclage group was the highest,the emergency cerclage group was the second,and the conservative treatment group was the lowest.3.the prolongation of pregnancy time between the three groups was compared with that of Chiχ~2=42.630,P<0.00,and the difference was statistically significant.The effective rate of the preventive cerclage group and the emergency cerclage group was similar,and the conservative treatment group was less effective.The difference between the three groups of patients in different gestational weeks wasχ~2=27.887,P<0.05,the difference was statistically significant.The prevention of cerclage group was the largest in the average delivery week,the emergency cerclage group was the second,and the conservative treatment group was the smallest.The difference of cervical width between treatment group and failure group was statistically significant(P<0.05).The age,parity,parity,abortion times and cervical length of treatment group in treatment success group and failure group were all P>0.05,the difference was not statistically significant.In the treatment group,the effective group and the failure group,the pregnancy week,the way of pregnancy,the expansion of the cervix,the single fetus/multiple fetus,and the history of premature birth were P<0.05,and the difference was statistically significant.Use the result of treatment as the dependent variable,pregnancy weeks,the cervical condition,the mode of pregnancy,the treatment,the opening of the cervix,the single fetus/multiple fetus,the history of preterm birth as the independent variable,the multiple factors Logistic regression analysis were done.the result showed that IVF,The pregnancy week was more than 24weeks or not,cervical expansion are risk factors affecting the success of treatment.Conclusion 1.The diagnostic criteria and surgical indications of cervical incompetence should be further unified and clear.Only when the diagnosis of cervical incompetence is strictly mastered and the indication of the operation is clear,McDonald cervix cerclage can effectively improve the outcome of pregnancy.2.Prophylactic cervical cerclage can achieve better clinical outcomes than emergency cerclage.Conservative treatment is not recommended for patients with cervical incompetence.Clinical treatment should be used to evaluate different individuals and clinical conditions to choose appropriate treatment.3.Assisted reproduction,when the gestational age exceeds 24 weeks,the degree of cervical dilatation may be risk factors for the treatment.