Analysis Of High Risk Factors And Clinical Outcomes Of Cervical Insufficiency

Objective:To design a retrospective case-control study group to explore the risk factors affecting cervical insufficiency and the impact of cervical cerclage at different timings on the mother and infant outcome in the case group,so as to improve the early screening rate and Diagnosis rate,the purpose of timely treatment measures to prevent miscarriage or premature birth.Methods:1.Select the clinical data of 176 pregnant women with cervical insufficiency(all singles)who had regular birth check-ups and delivered at the First Hospital of Shanxi Medical University from January 2017 to December 2019 and randomly selected from the same period in Shanxi Medical College.A retrospective investigation and analysis were performed on 176 normal pregnant women who had regular birth check-ups and delivered at University First Hospital,and a case-control study was designed.In the case group,18 patients chose conservative treatment,and the remaining 158 were pregnant women undergoing transvaginal cervical cerclage(modified MacDonald style).According to the timing of different operations,they were divided into prophylactic cerclage(n = 112)and emergency cerclage(n = 46).2.Retrospective collection and analysis of the general situation of pregnant women and mother-infant outcomes: age,body mass index(BMI)before pregnancy,pregnancy methods(including natural conception,assisted reproductive conception),previous pregnancy and childbirth(including number of cervix during abortion,preterm birth History,history of cesarean section,history of emergency labor,history of prolonged second stage of labor),historyof cervical conic resection(specific conical approach and conical tissue size),uterine malformations(both bicornuate uterus),pregnancy complications(pregnancy Hypertension,gestational diabetes),pregnancy appendage abnormalities(placental abruption,placenta previa),other diseases(polycystic ovary syndrome,vaginitis);indications for cerclage,cervical canal conditions during cerclage,cerclage Gestational weeks,extended gestational weeks,delivery methods,gestational weeks of pregnancy;pregnancy outcomes(abortion,preterm,term,live birth),birth weight(g)of the newborn.To investigate the high-risk factors of cervical insufficiency in pregnant women and the clinical outcomes of cervical cerclage at different timings.Results:1.Comparison of the general situation of the case group and the control group:Comparing the general situation of the case group and the control group,it can be found that there is no statistically significant difference between the two in terms of age(P>0.05).Comparing the case group with the control group,it was found that the BMI,the number of miscarriages,and the number of pregnancies in the case group were larger than those in the control group,and the differences were statistically significant(P <0.05);while the parity in the control group(0.57 ± 0.62)was greater than that in the case group(0.26 ± 0.48),the difference was also statistically significant(P <0.05).2.Single-factor analysis of risk factors in case group and control group: high-risk factors include:assisted reproductive technology,cervical cone resection history,BMI before pregnancy,polycystic ovary syndrome,history of premature birth,history of sudden birth,placenta previa,second stage of labor The history of prolongation,history of cesarean section,history of vaginitis,and history of uterine uterine operation were significantly different(P<0.05).3.Logistic regression analysis of risk factors that may affect cervical structure and function,leading to cervical insufficiency,found ART(OR=0.076,95%CI=0.013-0.458),history of uterine cervix(OR=0.013,95% CI)=0.002-0.069),PCOS(OR = 0.126,95% CI = 0.023-0.689),history of preterm birth(OR=28.911,95% CI =4.290-194.861),history of cervical coneectomy(OR=0.205,95% CI=0.056-0.746),BMIbefore pregnancy(OR=1.164,95%CI=1.051-1.289),history of sudden delivery(OR=0.269,95% CI=0.079-0.920),vaginitis(OR = 0.330,95% CI = 0.156-0.700),history of prolonged second birth(OR=0.239,95%CI=0.090-0.635),and history of cesarean section(OR =0.197,95% CI=0.065-0.595)are high risks that affect pregnant women with cervical insufficiency factor.4.Comparison of pregnancy outcomes between the case group and the control group: Comparing the pregnancy outcomes of the two groups,the miscarriage rate of the case group(14.2%)was higher than that of the control group(8.5%),and the difference was not statistically significant(P>0.05).The preterm birth rate(42%)was higher than that of the control group(22.7%),and the difference was statistically significant(P <0.05);the full-term birth rate and live birth rate in the case group were lower than the control group,and the difference was statistically significant(P<0.05);the low birth weight infants in the case group(54.5%)were significantly higher than the control group(13.6%),and the difference was statistically significant(P<0.05).5.Comparison of general conditions and pregnancy status in the prophylactic cerclage group and the emergency cerclage group: there was no statistically significant difference in age and parity(P> 0.05);the number of pregnancies,miscarriages,and ring in the cervix The length of the cervix before prolongation,prolonged gestational weeks,gestational weeks of delivery,and birth weight of the newborn were higher than those of the emergency circumcision group,and the difference was statistically significant(P<0.05);In the emergency cerclage group,there was a statistically significant difference between the two(P<0.05).6.Comparison of pregnancy outcomes between the prophylactic and emergency cerclage groups: Compared with the two surgical groups,the preterm(30.4%)and miscarriage rates(7.1%)of the prophylactic cerclage group were lower than the emergency cerclage Group(27.1% and65.2%),the difference was statistically significant(P<0.05);while the full-term birth rate(13.0%)and live birth rate(71.7%)of the emergency cerclage group were lower than the prophylactic ring Zha group,the difference was statistically significant(P <0.05).Conclusions:1.There are many high-risk factors affecting cervical insufficiency,including: assisted reproductive technology(ART),a history of cervical coneectomy,a history of cesarean section,a history of uterine uterine operation,a history of prolonged second stage of labor,a history of vaginitis,a history of preterm birth,and more Cystic ovary syndrome(PCOS),history of sudden birth,BMI before pregnancy,attach importance to the perinatal delivery of pregnant women with the above-mentioned high risk factors,and regularly educate and screen to improve the diagnosis rate and take early treatment measures to improve pregnancy outcomes.2.Preventive cervical cerclage is better than emergency cervical cerclage in prolonging the gestational week,reducing miscarriage and premature delivery,and improving pregnancy outcomes.Therefore,early detection and timely measures should be taken to effectively improve maternal and infant outcomes.