Abstract：
OBJECTIVE: The aim of this study was to compare the efficacy of cervical cerclage with spontaneous follow-up strategy on pregnancy duration and neonatal outcomes in women with visible or prolapsed fetal membranes.
METHODS: Patients who were referred to a single tertiary care centre between 1st January 2017 and 31st December 2022 were included in this comparative, retrospective cohort study. Patients were divided into two groups, those undergoing cerclage and those followed with no-cerclage. The range of pregnancy weeks for cerclage is between 18th and 27+6 weeks.
RESULTS: A total of 106 cases were reviewed and nine were excluded. Based on shared decision making, cervical cerclage was performed in 76 patients (78.3 %) and 21 patients (21.6 %) were medically treated in no-cerclage group if there was no early rupture of the fetal membranes. The gestational age at delivery was 29.8 ± 6 [Median=30 (19-38)] weeks in the cerclage group and 25.8 ± 2.9 [Median=25 (19-32)] weeks in the no-cerclage group (p=0.004). Pregnancy prolongation was significantly longer in the cerclage group compared to the no-cerclage group (55 ± 48.6 days [Median=28 (3-138)] vs. 12 ± 17.9 days [Median=9 (1-52)]; p<0.001). Take home baby rate was 58/76 (76.3 %) in cerclage group vs. 8/21 (38 %) in no-cerclage group. In the post-24 week cerclage group the absolute risk reduction for pregnancy loss was 50 % (95 % CI=21.7-78.2).
CONCLUSIONS: Cervical cerclage applied before and after 24 weeks (until 27+6 weeks) increased take home baby rate in women with visible or prolapsed fetal membranes without increasing adverse maternal outcome when compared with no-cerclage group.
METHODS: Patients who were referred to a single tertiary care centre between 1st January 2017 and 31st December 2022 were included in this comparative, retrospective cohort study. Patients were divided into two groups, those undergoing cerclage and those followed with no-cerclage. The range of pregnancy weeks for cerclage is between 18th and 27+6 weeks.
RESULTS: A total of 106 cases were reviewed and nine were excluded. Based on shared decision making, cervical cerclage was performed in 76 patients (78.3 %) and 21 patients (21.6 %) were medically treated in no-cerclage group if there was no early rupture of the fetal membranes. The gestational age at delivery was 29.8 ± 6 [Median=30 (19-38)] weeks in the cerclage group and 25.8 ± 2.9 [Median=25 (19-32)] weeks in the no-cerclage group (p=0.004). Pregnancy prolongation was significantly longer in the cerclage group compared to the no-cerclage group (55 ± 48.6 days [Median=28 (3-138)] vs. 12 ± 17.9 days [Median=9 (1-52)]; p<0.001). Take home baby rate was 58/76 (76.3 %) in cerclage group vs. 8/21 (38 %) in no-cerclage group. In the post-24 week cerclage group the absolute risk reduction for pregnancy loss was 50 % (95 % CI=21.7-78.2).
CONCLUSIONS: Cervical cerclage applied before and after 24 weeks (until 27+6 weeks) increased take home baby rate in women with visible or prolapsed fetal membranes without increasing adverse maternal outcome when compared with no-cerclage group.
摘要：
目的：本研究的目的是比较宫颈环扎术与自发随访策略对胎膜可见或脱垂妇女妊娠持续时间和新生儿结局的疗效。
方法：在2017年1月1日至2022年12月31日期间转诊至单一三级护理中心的患者被纳入本比较，回顾性队列研究。患者分为两组，那些接受环扎的人和那些没有环扎的人。环扎术的妊娠周数范围为18至27+6周。
结果：共检查106例，排除9例。基于共同决策，在无早期胎膜破裂的情况下，76例（78.3％）和21例（21.6％）的宫颈环扎患者接受了药物治疗。环扎组分娩时的胎龄为29.8±6[中位数=30（19-38）]周，非环扎组为25.8±2.9[中位数=25（19-32）]周（p=0.004）。与无环扎组相比，环扎组的妊娠延长时间明显更长（55±48.6天[中位数=28（3-138）]与12±17.9天[中位数=9(1-52)];p<0.001)。环扎组的带回家婴儿率为58/76（76.3％）。无环扎组8/21(38%)。在24周后环扎组中，妊娠丢失的绝对风险降低为50％（95％CI=21.7-78.2）。
结论：与无环扎组相比，在24周之前和之后（直到27+6周）应用宫颈环扎组可增加胎膜可见或脱垂的妇女的带回家婴儿率，而不会增加不良的产妇结局。
方法：在2017年1月1日至2022年12月31日期间转诊至单一三级护理中心的患者被纳入本比较，回顾性队列研究。患者分为两组，那些接受环扎的人和那些没有环扎的人。环扎术的妊娠周数范围为18至27+6周。
结果：共检查106例，排除9例。基于共同决策，在无早期胎膜破裂的情况下，76例（78.3％）和21例（21.6％）的宫颈环扎患者接受了药物治疗。环扎组分娩时的胎龄为29.8±6[中位数=30（19-38）]周，非环扎组为25.8±2.9[中位数=25（19-32）]周（p=0.004）。与无环扎组相比，环扎组的妊娠延长时间明显更长（55±48.6天[中位数=28（3-138）]与12±17.9天[中位数=9(1-52)];p<0.001)。环扎组的带回家婴儿率为58/76（76.3％）。无环扎组8/21(38%)。在24周后环扎组中，妊娠丢失的绝对风险降低为50％（95％CI=21.7-78.2）。
结论：与无环扎组相比，在24周之前和之后（直到27+6周）应用宫颈环扎组可增加胎膜可见或脱垂的妇女的带回家婴儿率，而不会增加不良的产妇结局。
