Clinical Efficacy Analysis Of 96 Cases Of Emergency Cervical Cerclage

Objective:To investigate the clinical efficacy of emergency cervical cerclage in the treatment of patients with cervical shortening detected by ultrasound in the second trimester,or endocervical funnel formation with cervical shortening,with or without amniotic sac prolapse on physical examination.Methods:The clinical data of 96 patients with cervical insufficiency who were hospitalized in the Department of Obstetrics of the First Hospital of Shanxi Medical University from January 2014 to December 2021 and found to have dilated cervical canal and shortened cervix with or without amniotic sac prolapse by ultrasound and/or physical examination were retrospectively analyzed and divided into 3 groups according to the length of the cervix at the time of surgery: <1cm group,≥1cm and <2.5cm group,≥2.5cm group.The pregnancy outcomes and neonatal survival were compared between the 3 groups.Results:(1)Emergency cervical cerclage was performed in 96 patients(65 singleton and 31twin)and was successful in 87 cases(58 singleton and 29 twin),with a success rate of90.63%.The successful cases extended the gestational age by 14～165 days,with 5 viable aborted babies,43 preterm babies and 39 full-term babies,resulting in 116 surviving newborns.(2)Statistically significant differences(P<0.05)in gestational age,days of prolonged labour,neonatal survival rate,cumulative delivery rate and neonatal weight between the 3 groups.(3)Emergency cervical cerclage in 4 extreme cases(0 mm cervical length with prolapsed amniotic sac in the vagina),1 successful and 3 unsuccessful due to uncontrollable contractions.(4)Prophylactic cervical cerclage was performed in 3 patients and emergency cervical cerclage was repeated in the second trimester with dilatation of the cervical canal and shortening of the cervix,1 case was successful,1 case had uncontrollable contractions and 1 case developed chorioamnionitis.(5)Of the 96 patients,26(27.08%)had a history of mid-to late pregnancy miscarriage and preterm delivery,29(30.21%)had a history of cervical trauma,25(26.04%)were conceived by in vitro fertilization-embryo transfer(IVF-ET),31(32.29%)were twin pregnancies,30(31.25%)had diabetes before or during pregnancy;27(28.13%)had a combination of delayed insulin release,and 28(29.17%)had thyroid disease,13(13.54%)had polycystic ovary syndrome(PCOS)and 42(43.75%)had a pre-pregnancy BMI at or above the overweight level,which may be associated with risk factors for cervical insufficiency.Conclusion:Emergency cervical cerclage is effective in improving pregnancy outcomes,prolonging gestation and improving neonatal survival in patients with dilated and shortened cervical canals,and is most effective when the cervical length is ≥2.5 cm,decreasing as the length of the cervix shortens.