PDF(Pubmed)
Abstract：
BACKGROUND: Cervical cerclage is the only effective treatment for cervical insufficiency, effectively preventing late miscarriage and preterm birth. The effectiveness and safety of emergency cervical cerclage (ECC) as an emergency treatment when the cervix is already dilated or when there is protrusion of the fetal membranes into the vagina remain controversial, especially in pregnancies at 24-28 weeks when the fetus is viable. There is still no consensus on whether emergency cervical cerclage should be performed in such cases.
OBJECTIVE: To investigate the effectiveness and safety of emergency cervical cerclage in singleton pregnant women at 24-28 weeks of gestation.
METHODS: This study employed a single-center prospective cohort design, enrolling singleton pregnant women at 24-28 weeks of gestation with ultrasound or physical examination indicating cervical dilation or even membrane protrusion. Emergency cervical cerclage was compared with conservative treatment. The primary endpoints included a comprehensive assessment of perinatal pregnancy loss, significant neonatal morbidity, and adverse neonatal outcomes. Secondary endpoints included prolonged gestational age, preterm birth, neonatal hospitalization rate, premature rupture of membranes, and intrauterine infection/chorioamnionitis.
RESULTS: From June 2021 to March 2023, a total of 133 pregnant women participated in this study, with 125 completing the trial, and were allocated to either the Emergency Cervical Cerclage (ECC) group (72 cases) or the conservative treatment group (53 cases) based on informed consent from the pregnant women. The rate of adverse neonatal outcomes was 8.33% in the ECC group and 26.42% in the conservative treatment (CT) group, with a statistically significant difference (P = 0.06). There were no significant differences between the two groups in terms of perinatal pregnancy loss and significant neonatal morbidity. The conservative treatment group had a mean prolonged gestational age of 63.0 (23.0, 79.5) days, while the ECC group had 84.0 (72.5, 89.0) days, with a statistically significant difference between the two groups (P < 0.001). Compared with CT group, the ECC group showed a significantly reduced incidence of preterm birth before 28 weeks, 32 weeks, and 34 weeks, with statistical significance (P = 0.046, 0.007, 0.001), as well as a significantly decreased neonatal hospitalization rate (P = 0.013, 0.031). Additionally, ECC treatment did not increase the risk of preterm premature rupture of membranes or intrauterine infection/chorioamnionitis, with no statistically significant differences (P = 0.406, 0.397).
CONCLUSIONS: In singleton pregnant women with cervical insufficiency at 24-28 weeks of gestation, emergency cervical cerclage can reduce adverse neonatal pregnancy outcomes, effectively prolong gestational age, decrease preterm births before 28 weeks, 32 weeks, and 34 weeks, lower neonatal hospitalization rates, and does not increase the risk of preterm premature rupture of membranes or intrauterine infection/chorioamnionitis.
OBJECTIVE: To investigate the effectiveness and safety of emergency cervical cerclage in singleton pregnant women at 24-28 weeks of gestation.
METHODS: This study employed a single-center prospective cohort design, enrolling singleton pregnant women at 24-28 weeks of gestation with ultrasound or physical examination indicating cervical dilation or even membrane protrusion. Emergency cervical cerclage was compared with conservative treatment. The primary endpoints included a comprehensive assessment of perinatal pregnancy loss, significant neonatal morbidity, and adverse neonatal outcomes. Secondary endpoints included prolonged gestational age, preterm birth, neonatal hospitalization rate, premature rupture of membranes, and intrauterine infection/chorioamnionitis.
RESULTS: From June 2021 to March 2023, a total of 133 pregnant women participated in this study, with 125 completing the trial, and were allocated to either the Emergency Cervical Cerclage (ECC) group (72 cases) or the conservative treatment group (53 cases) based on informed consent from the pregnant women. The rate of adverse neonatal outcomes was 8.33% in the ECC group and 26.42% in the conservative treatment (CT) group, with a statistically significant difference (P = 0.06). There were no significant differences between the two groups in terms of perinatal pregnancy loss and significant neonatal morbidity. The conservative treatment group had a mean prolonged gestational age of 63.0 (23.0, 79.5) days, while the ECC group had 84.0 (72.5, 89.0) days, with a statistically significant difference between the two groups (P < 0.001). Compared with CT group, the ECC group showed a significantly reduced incidence of preterm birth before 28 weeks, 32 weeks, and 34 weeks, with statistical significance (P = 0.046, 0.007, 0.001), as well as a significantly decreased neonatal hospitalization rate (P = 0.013, 0.031). Additionally, ECC treatment did not increase the risk of preterm premature rupture of membranes or intrauterine infection/chorioamnionitis, with no statistically significant differences (P = 0.406, 0.397).
CONCLUSIONS: In singleton pregnant women with cervical insufficiency at 24-28 weeks of gestation, emergency cervical cerclage can reduce adverse neonatal pregnancy outcomes, effectively prolong gestational age, decrease preterm births before 28 weeks, 32 weeks, and 34 weeks, lower neonatal hospitalization rates, and does not increase the risk of preterm premature rupture of membranes or intrauterine infection/chorioamnionitis.
摘要：
背景：宫颈环扎术是治疗宫颈机能不全的唯一有效方法，有效预防晚期流产和早产。当子宫颈已经扩张或胎膜突出进入阴道时，紧急宫颈环扎术（ECC）作为紧急治疗的有效性和安全性仍存在争议，特别是在24-28周的怀孕时，胎儿是可行的。在这种情况下，是否应进行紧急宫颈环扎术仍未达成共识。
目的：探讨妊娠24～28周单胎孕妇行紧急宫颈环扎术的有效性和安全性。
方法：本研究采用单中心前瞻性队列设计，在妊娠24-28周时，接受超声或体格检查表明宫颈扩张甚至膜突出的单胎孕妇。将急诊宫颈环扎术与保守治疗进行比较。主要终点包括围产期妊娠丢失的综合评估，显著的新生儿发病率，和不良的新生儿结局。次要终点包括延长胎龄，早产,新生儿住院率,胎膜早破,和宫内感染/绒毛膜羊膜炎。
结果：从2021年6月到2023年3月，共有133名孕妇参加了这项研究，125人完成了审判，根据孕妇的知情同意，将其分为急诊宫颈环扎术（ECC）组（72例）或保守治疗组（53例）。ECC组为8.33%,保守治疗(CT)组为26.42%,差异有统计学意义(P=0.06)。两组在围产期妊娠丢失和新生儿发病率方面没有显着差异。保守治疗组平均延长胎龄63.0(23.0,79.5)天,而ECC组有84.0（72.5，89.0）天，两组间差异有统计学意义(P<0.001)。与CT组相比,ECC组显示28周前早产发生率显著降低，32周,34周,具有统计学意义(P=0.046,0.007,0.001),新生儿住院率显着下降（P=0.013，0.031）。此外,ECC治疗并未增加早产胎膜早破或宫内感染/绒毛膜羊膜炎的风险，差异无统计学意义(P=0.406、0.397)。
结论：在妊娠24-28周时宫颈机能不全的单胎孕妇中，急诊宫颈环扎术可减轻新生儿不良妊娠结局,有效延长胎龄，在28周之前减少早产，32周,34周,新生儿住院率较低，并且不会增加早产胎膜早破或宫内感染/绒毛膜羊膜炎的风险。
目的：探讨妊娠24～28周单胎孕妇行紧急宫颈环扎术的有效性和安全性。
方法：本研究采用单中心前瞻性队列设计，在妊娠24-28周时，接受超声或体格检查表明宫颈扩张甚至膜突出的单胎孕妇。将急诊宫颈环扎术与保守治疗进行比较。主要终点包括围产期妊娠丢失的综合评估，显著的新生儿发病率，和不良的新生儿结局。次要终点包括延长胎龄，早产,新生儿住院率,胎膜早破,和宫内感染/绒毛膜羊膜炎。
结果：从2021年6月到2023年3月，共有133名孕妇参加了这项研究，125人完成了审判，根据孕妇的知情同意，将其分为急诊宫颈环扎术（ECC）组（72例）或保守治疗组（53例）。ECC组为8.33%,保守治疗(CT)组为26.42%,差异有统计学意义(P=0.06)。两组在围产期妊娠丢失和新生儿发病率方面没有显着差异。保守治疗组平均延长胎龄63.0(23.0,79.5)天,而ECC组有84.0（72.5，89.0）天，两组间差异有统计学意义(P<0.001)。与CT组相比,ECC组显示28周前早产发生率显著降低，32周,34周,具有统计学意义(P=0.046,0.007,0.001),新生儿住院率显着下降（P=0.013，0.031）。此外,ECC治疗并未增加早产胎膜早破或宫内感染/绒毛膜羊膜炎的风险，差异无统计学意义(P=0.406、0.397)。
结论：在妊娠24-28周时宫颈机能不全的单胎孕妇中，急诊宫颈环扎术可减轻新生儿不良妊娠结局,有效延长胎龄，在28周之前减少早产，32周,34周,新生儿住院率较低，并且不会增加早产胎膜早破或宫内感染/绒毛膜羊膜炎的风险。
