| Objective:The pregnancy outcomes and pregnancy outcomes related factors in the transvaginal cervical cerclage were analyzed to provide clinical reference for improving the success rate of surgery,reducing the rate of preterm birth and improving pregnancy outcomes.Method:The clinical data of 33 pregnant women diagnosed with cervical insufficiency and undergoing transcervical cerclage during the obstetric department of the First Affiliated Hospital of Dalian Medical University from November 2015 to November 2019 were selected.According to the vaginal secretion culture results before cerclage,they were divided into 18 cases of vaginal secretion culture positive group and 15 cases of negative group;functional cervical length was measured by transvaginal ultrasound before cerclage,and they were divided into 9 cases with FCL?25mm group,16 cases with 10?FCL<25mm group and 8 cases with FCL<10mm group;all pregnant women undergoing emergency cervical cerclage have cervical dilatation,according to the presence or absence of membranes bulging through external cervix,they were divided into 7 cases in the bulging group and 15 cases in the non-bulging group.Pregnancy outcomes were compared between groups,the factors that might be associated with pregnancy outcomes were analyzed.SPSS 24.0 software was used for data processing.For the measurement data,first perform a normality test,if it meets the normal distribution,used the mean ± standard deviation(`X±S)description,the t test between the two groups and the one-way analysis of variance between the three groups are used to compare the differences between the groups.If the variances among the three groups are equal,the t-test between the two groups is used to compare the differences within the groups;if the variance among the three groups is uneven,the non-parametrictest is used to compare the differences within the groups.The skewed distribution is described by median(minimum to maximum),and non-parametric tests are used to compare differences between groups.Count data was described by frequency and rate,and Fisher's exact probability method was used to compare differences between groups.All tests were two-sided,the test level ?=0.05,P<0.05 indicated that the difference was statistically significant.Results:1.The ages of 33 pregnant women were 30.94±5.28 years,pregnancies 2(1-8),parities0(0-1),history of abortion in the second midterm pregnancy/preterm birth 1(0-2),6 cases of history of Hysteroscopy,1 case of history of cervical cone resection,11 cases of prophylactic cervical cerclage,22 cases of emergency cervical cerclage.The median gestational week of cerclage of was 23.14 weeks,the median gestational week of delivery was 38.29 weeks,the prolonged gestation week was 14.61±6.85 weeks,the rate of live birth was 97%,the rate of term birth was 66.7%,and the rate of preterm birth was30.3%.The neonatal weight was 2904.87±941.85 g,the rate of neonatal asphyxia was12.5%,the rate of incidence of neonatal complications was 25%,the rate of neonatal to NICU was 25%,and there were no perinatal deaths.There were 4 cases of premature rupture of membranes(12.1%),8 cases of intrauterine infection(24.2%),3 cases of cerclage line displacement(9.1%),no serious complications such as cervical laceration and sepsis.2.The median gestational week of cerclage in the positive group was greater than that in the negative group(24.43 vs 19.71weeks),and the difference was statistically significant(P < 0.05).The prolonged gestational week(18.10±5.31 weeks)and the median gestational week of delivery(38.43 weeks)in the negative group were greater than the prolonged gestational week(11.69±6.74 weeks)and the median gestational week of delivery(37.71 weeks)in the positive group,the differences in the prolonged gestational week was statistically significant(P < 0.05)),but there was no statistically significant difference in the gestational weeks of delivery(P > 0.05).The rate of incidence of intrauterine infection in the positive group was higher than that in thenegative group(39.9% vs 6.7%),and the difference was statistically significant(P <0.05).The neonatal weight in the negative group was greater than that in the positive group(3256.06±673.72 vs 2595.00±1050.67g),and the difference was statistically significant(P<0.05).There was no significant difference in rate of preterm birth,rate of neonatal asphyxia,rate of incidence of neonatal complications and rate of neonatal to NICU between the two groups(P>0.05).3.The median gestational week of cerclage in the 10?FCL<25mm group and the FCL<10mm group were greater than those in the FCL?25mm group,and the difference was statistically significant(P < 0.05),while there was no statistically significant difference in the median gestational week of cerclage in 10?FCL < 25 mm group compared with FCL<10mm group(P>0.05).The prolonged gestational week and the neonatal weight in the FCL?25mm group were greater than those in the FCL<10mm group,and the difference were statistically significant(P < 0.05).The rate of neonatal asphyxia in the FCL < 10 mm group was higher than that in the 10?FCL < 25 mm group,and the rate of incidence of neonatal complications was higher in the FCL <10mm group than that in the FCL?25mm group,and the difference were statistically significant(P < 0.05).There were no significant differences in gestational week of delivery,rate of preterm birth,rate of live birth,and rate of incidence of intrauterine infection in the three groups(P>0.05).4.The prolonged gestational week and the median gestational week of delivery in the non-bulging group were larger than those in the bulging group,respectively13.11±4.45 vs 8.0±5.77 weeks,38.29 vs 28.57 weeks,and the differences were statistically significant(P < 0.05).The rate of neonatal asphyxia(6.7%),the rate of incidence of neonatal complications(26.7%),and the rate of neonatal to NICU(20%)in the non-bulging group were lower than the rate of neonatal asphyxia(42.9%),the rate of incidence of neonatal complications(71.4%),and the rate of neonatal to NICU(57.1%)in the bulging group,but the differences were not statistically significant(P>0.05).There was no significant difference in rate of preterm birth,rate of intrauterine infection,and neonatal weight between the two groups(P>0.05).Conclusions:1.Pregnant women with cervical insufficiency undergoing transcervical cervical cerclage have higher rate of live birth,lower rate of premature birth,and better surgical safety.2.Positive vaginal secretion culture,functional cervical length before cerclage,and amniotic swelling may be related to the pregnancy outcome of cervical cerclage,which needs to be further confirmed by large sample studies. |
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