PDF(Pubmed)
Abstract：
OBJECTIVE: Preterm birth (PTB) is the leading cause of neonatal morbidity and mortality worldwide, and cervical incompetence (CIC) is a significant contribution. Cervical cerclage (CC) is an effective obstetric intervention. However, many clinical factors affect the success rate of surgery. The objective was to investigate and compare the pregnancy and neonatal outcomes of patients who underwent ultrasound- and physical examination-indicated cervical cerclage and to explore the influencing factors of preterm delivery before 34 weeks.
METHODS: The sociodemographic characteristics and clinical data of patients with a diagnosis of cervical incompetence who underwent ultrasound- and physical examination-indicated transvaginal cervical cerclage at Nanjing Maternal and Child Health Hospital from January 2020 to December 2022 were retrospectively analyzed. The pregnancy and neonatal outcomes of the patients were evaluated. Continuous variables were compared using Student\'s t test (for normally distributed data) or the Mann-Whitney U test (for nonnormally distributed data). Categorical variables were analysed using the chi-square test or Fisher\'s exact test. Additionally, logistic regression analyses and receiver operating characteristic curves were used to evaluate the associations of inflammatory markers with maternal and neonatal outcomes.
RESULTS: This study included 141 participants who underwent cervical cerclage, including 71 with ultrasound-indicated cerclage and 70 with physical examination-indicated cerclage. Compared to those in the ultrasound-indicated cerclage group, the duration from cerclage to delivery, birth weight, and APGAR score in the physical examination-indicated cerclage group were significantly lower, and the rates of delivery at < 28 weeks, < 32 weeks, < 34 weeks, and < 37 weeks of gestation and neonatal mortality were significantly higher (all P < 0.05). Compared to those in the physical ultrasound-indicated cerclage group, in the physical examination-indicated cerclage group, maternal blood inflammatory markers, such as C-reactive protein (CRP), the systemic immune-inflammation index (SII) and the systemic inflammation response index (SIRI) were significantly higher (P < 0.05). Additionally, maternal blood inflammatory markers, such as the CRP, white blood cell count, platelet to lymphocyte ratio (PLR), SII, and SIRI were significantly higher in the group with delivery before 34 weeks of gestation. Furthermore, the results demonstrated that twin pregnancy had the highest OR for preterm delivery before 34 weeks of gestation (OR = 3.829; 95% CI 1.413-10.373; P = 0.008), as well as the following: the SII level (OR = 1.001; 95% CI 1.000-1.002; P = 0.003) and CRP level (OR = 1.083; 95% CI 1.038-1.131; P = 0.022). The risk factors for preterm delivery before 34 weeks of gestation were twin gestation, an increased SII level and an increased CRP level, which had good combined predictive value.
CONCLUSIONS: In patients with cervical insufficiency, ultrasound-indicated cervical cerclage appears to lead to better pregnancy outcomes than physical examination-indicated cerclage. Twin pregnancy and maternal blood inflammatory markers, such as the CRP level and the SII, are associated with preterm delivery before 34 weeks of gestation.
METHODS: The sociodemographic characteristics and clinical data of patients with a diagnosis of cervical incompetence who underwent ultrasound- and physical examination-indicated transvaginal cervical cerclage at Nanjing Maternal and Child Health Hospital from January 2020 to December 2022 were retrospectively analyzed. The pregnancy and neonatal outcomes of the patients were evaluated. Continuous variables were compared using Student\'s t test (for normally distributed data) or the Mann-Whitney U test (for nonnormally distributed data). Categorical variables were analysed using the chi-square test or Fisher\'s exact test. Additionally, logistic regression analyses and receiver operating characteristic curves were used to evaluate the associations of inflammatory markers with maternal and neonatal outcomes.
RESULTS: This study included 141 participants who underwent cervical cerclage, including 71 with ultrasound-indicated cerclage and 70 with physical examination-indicated cerclage. Compared to those in the ultrasound-indicated cerclage group, the duration from cerclage to delivery, birth weight, and APGAR score in the physical examination-indicated cerclage group were significantly lower, and the rates of delivery at < 28 weeks, < 32 weeks, < 34 weeks, and < 37 weeks of gestation and neonatal mortality were significantly higher (all P < 0.05). Compared to those in the physical ultrasound-indicated cerclage group, in the physical examination-indicated cerclage group, maternal blood inflammatory markers, such as C-reactive protein (CRP), the systemic immune-inflammation index (SII) and the systemic inflammation response index (SIRI) were significantly higher (P < 0.05). Additionally, maternal blood inflammatory markers, such as the CRP, white blood cell count, platelet to lymphocyte ratio (PLR), SII, and SIRI were significantly higher in the group with delivery before 34 weeks of gestation. Furthermore, the results demonstrated that twin pregnancy had the highest OR for preterm delivery before 34 weeks of gestation (OR = 3.829; 95% CI 1.413-10.373; P = 0.008), as well as the following: the SII level (OR = 1.001; 95% CI 1.000-1.002; P = 0.003) and CRP level (OR = 1.083; 95% CI 1.038-1.131; P = 0.022). The risk factors for preterm delivery before 34 weeks of gestation were twin gestation, an increased SII level and an increased CRP level, which had good combined predictive value.
CONCLUSIONS: In patients with cervical insufficiency, ultrasound-indicated cervical cerclage appears to lead to better pregnancy outcomes than physical examination-indicated cerclage. Twin pregnancy and maternal blood inflammatory markers, such as the CRP level and the SII, are associated with preterm delivery before 34 weeks of gestation.
摘要：
目的：早产（PTB）是全球新生儿发病和死亡的主要原因，宫颈功能不全（CIC）是一个重要的贡献。宫颈环扎术（CC）是一种有效的产科干预措施。然而,许多临床因素影响手术的成功率。目的是调查和比较超声和体格检查显示宫颈环扎术患者的妊娠和新生儿结局，并探讨34周前早产的影响因素。
方法：回顾性分析2020年1月至2022年12月南京市妇幼保健院诊断为宫颈机能不全、超声及体格检查显示经阴道宫颈环扎术患者的社会人口学特征及临床资料。评估患者的妊娠和新生儿结局。使用Studentt检验（对于正态分布数据）或Mann-WhitneyU检验（对于非正态分布数据）比较连续变量。使用卡方检验或Fisher精确检验分析分类变量。此外,采用logistic回归分析和受试者工作特征曲线评价炎症标志物与母婴结局的相关性.
结果：这项研究包括141名接受宫颈环扎术的参与者，包括71例超声指示的环扎和70例体检指示的环扎。与超声指示的环扎组相比，从环扎到分娩的持续时间，出生体重,体检指环扎组的APGAR评分明显降低，以及<28周时的分娩率，<32周,<34周,<37周和<37周的新生儿死亡率明显高于对照组(均P<0.05)。与物理超声指示的环扎组相比，在体检显示的环扎组中，母体血液炎症标志物，如C反应蛋白（CRP），全身免疫炎症反应指数(SII)和全身炎症反应指数(SIRI)均显著升高(P<0.05)。此外,母体血液炎症标志物，如CRP，白细胞计数,血小板与淋巴细胞比率（PLR），SII,在妊娠34周前分娩的组中，SIRI和SIRI明显更高。此外，结果表明，在妊娠34周之前，双胎妊娠对早产的OR最高（OR=3.829;95％CI1.413-10.373;P=0.008），以及以下：SII水平（OR=1.001；95％CI1.000-1.002；P=0.003）和CRP水平（OR=1.083；95％CI1.038-1.131；P=0.022）。妊娠34周前早产的危险因素为双胎妊娠,SII水平升高和CRP水平升高，具有良好的综合预测价值。
结论：在宫颈机能不全患者中，与体格检查显示的宫颈环扎术相比,超声显示的宫颈环扎术可能导致更好的妊娠结局.双胎妊娠和母体血液炎症标志物，如CRP水平和SII，与妊娠34周前早产有关。
方法：回顾性分析2020年1月至2022年12月南京市妇幼保健院诊断为宫颈机能不全、超声及体格检查显示经阴道宫颈环扎术患者的社会人口学特征及临床资料。评估患者的妊娠和新生儿结局。使用Studentt检验（对于正态分布数据）或Mann-WhitneyU检验（对于非正态分布数据）比较连续变量。使用卡方检验或Fisher精确检验分析分类变量。此外,采用logistic回归分析和受试者工作特征曲线评价炎症标志物与母婴结局的相关性.
结果：这项研究包括141名接受宫颈环扎术的参与者，包括71例超声指示的环扎和70例体检指示的环扎。与超声指示的环扎组相比，从环扎到分娩的持续时间，出生体重,体检指环扎组的APGAR评分明显降低，以及<28周时的分娩率，<32周,<34周,<37周和<37周的新生儿死亡率明显高于对照组(均P<0.05)。与物理超声指示的环扎组相比，在体检显示的环扎组中，母体血液炎症标志物，如C反应蛋白（CRP），全身免疫炎症反应指数(SII)和全身炎症反应指数(SIRI)均显著升高(P<0.05)。此外,母体血液炎症标志物，如CRP，白细胞计数,血小板与淋巴细胞比率（PLR），SII,在妊娠34周前分娩的组中，SIRI和SIRI明显更高。此外，结果表明，在妊娠34周之前，双胎妊娠对早产的OR最高（OR=3.829;95％CI1.413-10.373;P=0.008），以及以下：SII水平（OR=1.001；95％CI1.000-1.002；P=0.003）和CRP水平（OR=1.083；95％CI1.038-1.131；P=0.022）。妊娠34周前早产的危险因素为双胎妊娠,SII水平升高和CRP水平升高，具有良好的综合预测价值。
结论：在宫颈机能不全患者中，与体格检查显示的宫颈环扎术相比,超声显示的宫颈环扎术可能导致更好的妊娠结局.双胎妊娠和母体血液炎症标志物，如CRP水平和SII，与妊娠34周前早产有关。
