| Objective:To compare the outcomes of patients with cervical insufficiency for conservative treatment with those for cervical cerclage,the effects of conservative treatment and cervical cerclage,the timing of cervical cerclage,and the choice of surgical methods for pregnancy outcomes were discussed.Methods:A total of 371 patients with cervical insufficiency who were treated in the Second Affiliated Hospital of Soochow University from January 2010 to January 2020 were collected.Finally,231 patients with complete data entered the study.231 patients with cervical insufficiency were divided into conservative treatment group(n=63)and cervical cerclage group(n=168)according to different treatment methods.Patients with cervical insufficiency in this study experienced at least once abortion in the second and third trimester or premature pregnancy.A subgroup analysis was carried out based on the times of late abortion or premature pregnancy.Patients with a previous second and third trimester pregnancy miscarriage or premature delivery were divided into conservative treatment group(n=51)and the cervical cerclage group(n=59).Patients with two previous second and third trimester abortions or premature delivery were divided into conservative treatment group(n=12)and cervical cerclage group(n=87).Cervical cerclage was performed in patients who had experienced three or more second and third trimester pregnancy abortions or preterm labor(n=22).The pregnancy outcomes such as different gestational weeks,mode of delivery,abortion rate,live birth rate,neonatal birth weight,NICU transfer rate,incidence of pregnancy complications,and use rate of tocolytic drugs were analyzed and compared between the cervical cerclage group and conservative treatment to evaluate the benefit rate of cervical cerclage.According to the timing of cerclage,they were divided into preventive cerclage group(n=138)and sterss cerclage group(n=30);then they were divided into MacDonald group(n=68)and Shirodkar group(n=76)according to different methods of transvaginal cervical cerclage.Analysis and comparison of prolonged gestational weeks,different gestational weeks,delivery methods,miscarriage rates,live births rate,newborn birth weights,NICU transfer rate,incidence of pregnancy complications,and the use rate of tocolytic drugs were carried between different cerclage timing group and different transvaginal cervical cerclage surgical methods group.The further treatment methods and gestational weeks of pregnancy were analyzed in 24 cases of cervical cerclage failure group.Results:1.Compared with the conservative treatment group and the cervical cerclage group,there were no significant differences in abortion rate,live birth rate,neonatal birth weight,NICU transfer rate,incidence of pregnancy complications,and use rate of tocolytic drugs during pregnancy(P>0.05).The incidence of preterm birth between 34 and 37 weeks was higher(27.0%vs8.3%),the rate of cesarean section was lower(34.9%vs56.5%),and the rate of vaginal delivery was higher(60.3%vs38.1%)in the conservative treatment group,and the difference was statistically significant(P<0.05).2.According to the number of previous late abortions or premature births,it was divided into one,two,three or more late abortions or premature births,with 110,99,and 22 cases each.There was no significant difference in pregnancy outcome between the conservative treatment group(n=51)and cervical cerclage group(n=5 9)in once second and third trimester of pregnancy or premature delivery during the previous period group(P>0.05).In the patients who have experienced two abortions in the second and third trimester of pregnancy or premature delivery group,the conservative treatment group had a higher preterm birth rate between 34 and 37 weeks(58.3%vs6.9%)and lower term birth rate(25.0%vs75.9%)than that of cervical cerclage group(P<0.05).A total of 22 patients with three or more abortions in the second and third trimester of pregnancy or premature delivery were selected for cervical cerclage,17 for transvaginal cerclage,and 5 for transabdominal cerclage,including two cases(2/22,9.1%)of abortion,one case(1/22,4.5%)of vital infants in extremely preterm delivery at 26 weeks,4 cases(4/22,18.2%)of premature delivery,and 15 cases(15/22,68.2%)of term delivery.3.There were no significant differences among prolonged gestational weeks,different gestational weeks,delivery methods,miscarriage rates,live births rate,newborn birth weights,NICU transfer rate,incidence of pregnancy complications,and the use rate of tocolytic drugs between preventive cerclage group and sterss cerclage group.4.There were no significant differences among prolonged gestational weeks,different gestational weeks,delivery methods,miscarriage rates,live births rate,newborn birth weights,NICU transfer rate,incidence of pregnancy complications,and the use rate of tocolytic drugs between MacDonald group and Shirodkar group.The operation time and intraoperative blood loss in the MacDonald group were lower than those in the Shirodkar group(16.17±9.23min.vs.30.81±11.65min,11.52±9.76ml.vs.21.98±14.56ml).Compared with Shirodkar group,the MacDonald group had lower cesarean section rate(38.2%vs59.2%),higher vaginal delivery rate(55.9%vs35.5%),and the differences were statistically significant(P<0.05).5.In the 168 cases of cervical cerclage,there were 24 cases of cervical insufficiency with a history of cerclage failure.After re-pregnancy,16 patients underwent transvaginal cerclage and 8 underwent laparoscopic cerclage.Among them,one patient had miscarriage at 20 weeks(1/24,4.2%),one patient had viable infants at 26 weeks of very premature delivery(1/24,4.2%),four patients had premature labor(4/24,16.7%)and 18 patients had at term delivery(18/24,75.0%).Conclusions:1.Conservative treatment has no difference with late-term abortion compared with cervical cerclage.Cervical cerclage can reduce the incidence of preterm birth between 34 and 37 weeks.2.Cervical cerclage in patients with twice history of miscarriage or preterm birth can improve pregnancy outcomes.3.Preventive cerclage and sterss cerclage have similar effects on pregnancy outcomes.4.Compared with Shirodkar procedure,MacDonald procedure had shorter operation time and less intraoperative blood loss,and there was no significant difference in pregnancy outcome.5.Patients with cervical insufficiency who have failed previous cerclage can be cerclized again to obtain a good pregnancy outcome. |
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