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Abstract：
BACKGROUND: The leading hypothesis of the pathogenesis of cervical insufficiency suggests a role of cervical inflammation. Urogenital tract infections could play a causative role in this process. To test this hypothesis in women with a cervical cerclage, we aimed to retrospectively examine the relationship between gestational age (GA) at delivery and positive urogenital cultures.
METHODS: This single center retrospective study reviewed the records of all women with a singleton pregnancy that underwent cervical cerclage (n = 203) between 2010 and 2020 at the University Hospital of Leuven, Belgium. Transvaginal cerclages were categorized as history indicated (TVC I, n = 94), ultrasound indicated (TVC II, n = 79) and clinically indicated (TVC III, n = 20). Additionally, ten women received transabdominal cerclage (TAC). Urogenital cultures (vaginal and urine) were taken before and after cerclage with 4-week intervals. Urogenital cultures were reported \'positive\' if urine and/or vaginal cultures showed significant growth of a microorganism. Treatment decision depended on culture growth and clinical presentation. The primary aim was to evaluate the association between the urogenital culture results and the GA at delivery, for each of the cerclage groups. Secondarily, to investigate the effect of antibiotic treatment of positive cultures on GA at delivery.
RESULTS: Positive pre-cerclage urogenital cultures were associated with lower GA at delivery in TVC III (positive culture 26w4d ± 40d vs. negative 29w6d ± 54d, p = 0.036). For TVC I, GA at delivery was longer when pre-cerclage urogenital cultures were positive (positive culture 38w0d ± 26d vs. negative 35w4d ± 42d, p = 0.035). Overall post-cerclage urogenital cultures status was not associated with a different GA at delivery. Treating patients with pre- or post-cerclage positive urogenital cultures did also not change GA at delivery.
CONCLUSIONS: Positive urogenital cultures taken before clinically indicated cerclage intervention may be associated with lower GA at delivery. However, there seems to be no benefit of antibiotic treatment or routine urogenital cultures during follow-up of asymptomatic women after cerclage placement.
METHODS: This single center retrospective study reviewed the records of all women with a singleton pregnancy that underwent cervical cerclage (n = 203) between 2010 and 2020 at the University Hospital of Leuven, Belgium. Transvaginal cerclages were categorized as history indicated (TVC I, n = 94), ultrasound indicated (TVC II, n = 79) and clinically indicated (TVC III, n = 20). Additionally, ten women received transabdominal cerclage (TAC). Urogenital cultures (vaginal and urine) were taken before and after cerclage with 4-week intervals. Urogenital cultures were reported \'positive\' if urine and/or vaginal cultures showed significant growth of a microorganism. Treatment decision depended on culture growth and clinical presentation. The primary aim was to evaluate the association between the urogenital culture results and the GA at delivery, for each of the cerclage groups. Secondarily, to investigate the effect of antibiotic treatment of positive cultures on GA at delivery.
RESULTS: Positive pre-cerclage urogenital cultures were associated with lower GA at delivery in TVC III (positive culture 26w4d ± 40d vs. negative 29w6d ± 54d, p = 0.036). For TVC I, GA at delivery was longer when pre-cerclage urogenital cultures were positive (positive culture 38w0d ± 26d vs. negative 35w4d ± 42d, p = 0.035). Overall post-cerclage urogenital cultures status was not associated with a different GA at delivery. Treating patients with pre- or post-cerclage positive urogenital cultures did also not change GA at delivery.
CONCLUSIONS: Positive urogenital cultures taken before clinically indicated cerclage intervention may be associated with lower GA at delivery. However, there seems to be no benefit of antibiotic treatment or routine urogenital cultures during follow-up of asymptomatic women after cerclage placement.
摘要：
背景：宫颈机能不全发病机制的主要假设提示了宫颈炎症的作用。泌尿生殖道感染可能在这一过程中起着致病作用。为了在宫颈环扎术女性身上检验这一假设，我们旨在回顾性研究分娩时胎龄(GA)与泌尿生殖道培养阳性之间的关系.
方法：这项单中心回顾性研究回顾了2010年至2020年在鲁汶大学医院接受宫颈环扎术（n=203）的所有单胎妊娠妇女的记录，比利时。经阴道环扎术按病史分类(TVCI，n=94),超声指示(TVCII，n=79)和临床指征(TVCIII，n=20）。此外,10名妇女接受了经腹环扎术（TAC）。在环扎前后间隔4周进行泌尿生殖道培养（阴道和尿液）。如果尿液和/或阴道培养物显示微生物的显着生长，则报告泌尿生殖道培养物呈“阳性”。治疗决定取决于培养物的生长和临床表现。主要目的是评估泌尿生殖道培养结果与分娩时的GA之间的关联。每个环扎组。其次，研究抗生素治疗阳性培养物对分娩时GA的影响。
结果：在TVCIII中，宫颈环扎前泌尿生殖道培养阳性与分娩时GA降低相关（阳性培养26w4d±40dvs.负29w6d±54d,p=0.036)。对于TVCI，当环扎前泌尿生殖道培养阳性时，分娩时的GA更长（阳性培养38w0d±26dvs.负35w4d±42d,p=0.035)。整体环扎后泌尿生殖系统培养状态与分娩时不同的GA无关。使用环扎前或后阳性泌尿生殖系统培养物治疗患者在分娩时也不会改变GA。
结论：在临床指示的环扎干预前采取阳性泌尿生殖道培养可能与分娩时降低GA相关。然而,在环扎术后无症状的女性随访期间,抗生素治疗或常规泌尿生殖道培养似乎没有益处.
方法：这项单中心回顾性研究回顾了2010年至2020年在鲁汶大学医院接受宫颈环扎术（n=203）的所有单胎妊娠妇女的记录，比利时。经阴道环扎术按病史分类(TVCI，n=94),超声指示(TVCII，n=79)和临床指征(TVCIII，n=20）。此外,10名妇女接受了经腹环扎术（TAC）。在环扎前后间隔4周进行泌尿生殖道培养（阴道和尿液）。如果尿液和/或阴道培养物显示微生物的显着生长，则报告泌尿生殖道培养物呈“阳性”。治疗决定取决于培养物的生长和临床表现。主要目的是评估泌尿生殖道培养结果与分娩时的GA之间的关联。每个环扎组。其次，研究抗生素治疗阳性培养物对分娩时GA的影响。
结果：在TVCIII中，宫颈环扎前泌尿生殖道培养阳性与分娩时GA降低相关（阳性培养26w4d±40dvs.负29w6d±54d,p=0.036)。对于TVCI，当环扎前泌尿生殖道培养阳性时，分娩时的GA更长（阳性培养38w0d±26dvs.负35w4d±42d,p=0.035)。整体环扎后泌尿生殖系统培养状态与分娩时不同的GA无关。使用环扎前或后阳性泌尿生殖系统培养物治疗患者在分娩时也不会改变GA。
结论：在临床指示的环扎干预前采取阳性泌尿生殖道培养可能与分娩时降低GA相关。然而,在环扎术后无症状的女性随访期间,抗生素治疗或常规泌尿生殖道培养似乎没有益处.
