| Objective:This study analyzed the pregnancy outcomes of women with cervical incompetence(CIC)who underwent vaginal cervical cerclage at different operation times during pregnancy and the influencing factors of prolonged pregnancy after operation,compared the clinical efficacy of cerclage at different operation times for CIC,and explored the clinical value of cervical cerclage in twin pregnancy,in order to reduce the incidence of abortion and preterm birth in the second and third trimesters of pregnancy,and reduce the incidence and death of perinatal infants.To provide clinical basis for improving perinatal outcome and provide clinical reference for standardized treatment of pregnancy complicated with CIC.Methods:From January 1,2016 to December 31,2019,the total number of obstetric deliveries in the First Affiliated Hospital of Kunming Medical University was 25969,with 943 twin pregnancies(3.63%)and 94 cervical cerclage(0.36%).The clinical data of 83 pregnant women with CIC diagnosed before and during pregnancy and suspected CIC who underwent transvaginal cervical cerclage during pregnancy were retrospectively analyzed,including 75 singleton pregnancies and 8 twin pregnancies.Maternal history,preoperative cervical length,cervical dilatation and amniotic sac protrusion,operation,delivery and neonatal conditions were collected.Seventy-five singleton pregnancies were divided into emergency cervical cerclage group(emergency group)and preventive cervical cerclage group(prevention group)according to the timing of cerclage.The-general information,surgical conditions and pregnancy outcomes of the two groups were compared,and the surgical effects and perinatal outcomes of cerclage at different timing of surgery were analyzed.According to the different prolongation time of pregnancy after cerclage,they were divided into groups with prolongation time ≤14 weeks(prolongation ≤ 14 weeks group)and groups with prolongation time>14 weeks(prolongation>14 weeks group)for inter-group comparison,and binary logistic regression analysis was used to analyze the influencing factors that may affect prolongation of pregnancy time after cerclage for singleton pregnancy.The clinical data of 8 pregnant women with twin pregnancy and their newborns were summarized,and the clinical value of transvaginal cervical cerclage in the second trimester of twin pregnancy was analyzed.Results:1.Comparing the general conditions and operation conditions between the emergency group and the prevention group,there were significant differences between the two groups in terms of previous full-term abortion,spontaneous abortion,number of induced abortions,gestational week of cervical ligation,preoperative cervical length,operation time,intraoperative bleeding,average hospitalization days,number of cases of postoperative uterine contractions,and use of uterine contraction inhibitors(P<0.05).2.Comparing the pregnancy outcome and complications between the emergency group and the prevention group,there were no significant differences between the two groups in terms of term rate,preterm delivery rate,the number of cases of cervical laceration,chorioamnionitis,postpartum hemorrhage,and preterm premature rupture of membranes(PPROM)(P>0.05);there were significant differences between the two groups in terms of prolonged pregnancy time and abortion rate(P<0.05).3.Comparing the neonatal condition between emergency group and prevention group,there were no significant differences between the two groups in neonatal asphyxia rate,neonatal survival rate and NICU occupancy rate(P>0.05);there were significant differences between the two groups in neonatal birth weight,low birth weight infants and Apgar score(P<0.05).4.Comparison of prolonged pregnancy time ≤14 weeks group and prolonged pregnancy time>14 weeks group,there were no significant differences between the two groups in age,pre-pregnancy BMI,preoperative peripheral blood WBC,serum CRP and the number of cases of chorioamnionitis(P>0.05);there were significant differences between the two groups in terms of the number of cases of pre-pregnancy BMI was ≥24kg/m2,prenatal peripheral blood WBC,serum CRP,gestational week of cerclage,preoperative cervical length,the number of cases of cervical length<25mm,dilatation of cervical internal orifice,funnel change of cervix,amniotic sac protrusion,scarred uterus,preoperative uterine contraction,postoperative uterine contraction and premature rupture of membranes(P<0.05).5.The gestational week of cerclage,cervical length<25 mm,dilatation of cervical internal orifice,change of cervical funnel,protrusion of amniotic sac,scarred uterus,preoperative uterine contraction,postoperative uterine contraction,premature rupture of membranes,prenatal peripheral blood WBC and serum CRP are the risk factors affecting the prolongation of pregnancy after cerclage for singleton pregnancy;Preoperative cervical length is a protective factor for prolonged pregnancy after cervical cerclage in singleton pregnancy.6.In 8 twin pregnancies,the average gestational prolongation time was 68.38 ±50.00 days,and the termination of gestational weeks ≥28 weeks accounted for 62.5%(5/8),and the neonatal survival rate was 50.0%(8/16).Conclusions:1.Transvaginal cervical cerclage(TVCC)during pregnancy is an effective method for the treatment of singleton pregnancy complicated with CIC,which is simple and has no serious surgical complications.2.Preventive cervical cerclage has definite curative effect.As a remedy in emergency situations,emergency cervical cerclage can prolong the pregnancy time appropriately and has certain clinical significance in improving the prognosis of perinatal infants.3.The prolongation of pregnancy after cervical cerclage for singleton pregnancy is affected by many factors.Cervical shortening with cervical orifice changes is an important factor affecting the prolongation of pregnancy after cerclage.Gestational week of cerclage,inflammation,infection,uterine contraction are also important factors affecting the prolongation of pregnancy after cerclage.4.Transvaginal cervical cerclage in twin pregnancy has certain clinical significance,but the number of cases is small,there is no comparative study of multiple samples.There is no strong evidence for the benefit of cervical cerclage in twin pregnancy.Whether cervical cerclage is performed should be comprehensively evaluated and the pros and cons should be weighed. |
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