Comparison Of The Effect Of Laparoscopic Cervical Cerclage And Transvaginal Cerclage In The Treatment Of Cervical Insufficiency During Pregnancy

Objective: Cervical insufficiency(CI),as a common cause of miscarriage and premature delivery in the second and third trimesters of pregnancy,its pathogenesis is still unclear,there is no gold standard for diagnosis,and there is also controversy in the treatment.Cervical cerclage is the only feasible method of surgical treatment,which can be divided into transvaginal and transabdominal surgery.The purpose of this article was to analyze and compare the pregnant women with cervical insufficiency,and to observe the effect of transvaginal cervical high cerclage and laparoscopic cervical cerclage on pregnancy outcome.METHODS: From March 2018 to October 2019,patients with cervical insufficiency were selected from Jiangxi Maternal and Child Health Hospital.The surgical methods were laparoscopic cervical cerclage(laparoscopic group)and transvaginal cervical high cervical cerclage(vaginal group).According to the inclusion and exclusion criteria,64 cases were screened,including 20 cases in the laparoscopic group and 44 cases in the vaginal group.Clinical data were collected.A retrospective analysis was conducted,and the mothers who did not give birth in our hospital were followed up by telephone.Results: Compared with the two groups,no complications such as massive hemorrhage,air embolism,anesthesia accident,electrolyte disorder occurred during the operation.There was no significant difference in premature rupture of membranes,intraoperative hemorrhage volume and postoperative hospital stay between the two groups(P > 0.05).In terms of operation time,the laparoscopic group was longer than the vaginal group(P < 0.05).In the laparoscopic group,the gestational week of cerclage was smaller than that of vaginal group(P<0.05),and there was no significant difference between the two groups in gestational week of delivery and neonatal weight(P>0.05).In terms of neonatal outcomes,which indicated no statistic difference in cerclage abortion,preterm delivery,live birth,and full-term birth ratesbetween the two groups(P > 0.05),but the laparoscopic group had higher live birth rates(100%)and full-term birth rates(85%)compared with the vaginal group(93%and 61%,respectively).Conclusion: Both cervical cerclage could be used as a surgical method to treat cervical insufficiency.For patients with repeated abortions,premature elderly women,precious infants assisted reproductive pregnancy,laparoscopic cerclage could achieve satisfactory results,but cesarean section was usually needed in childbirth,while vaginal cerclage was more convenient,and vaginal trial delivery could be conducted after operation.Laparoscopic cervical cerclage had a higher live and full-term rate than vaginal cerclage.Laparoscopic cerclage could also be used for better pregnancy outcome in patients who have never had a history of vaginal cervical cerclage before,and the appropriate cerclage method should be individually selected clinically.