PDF(Pubmed)
Abstract：
BACKGROUND: Transvaginal cervical length (TVCL) surveillance post-transvaginal cerclage placement is not universally performed, despite the correlated risk of short TVCL with spontaneous preterm birth (sPTB). This study evaluated if patients with a TVCL <2.5 cm after cerclage placement had higher odds of sPTB than those with a TVCL ≥2.5 cm after cerclage placement.
METHODS: This retrospective cohort study included patients with a singleton, non-anomalous gestation with a transvaginal cerclage who had TVCL surveillance post-cerclage placement. The primary outcome was the odds of sPTB among patients with TVCL <2.5 cm vs TVCL ≥2.5 cm after cerclage placement. Transvaginal cerclage placement indications included history indicated, physical exam indicated, and ultrasound indicated. Outcomes were assessed using univariate and multivariate analysis while adjusting for progesterone use, TVCL before cerclage placement, and cerclage indication.
RESULTS: The analysis included 210 patients, and the sPTB rate was 46.7%. Those with sPTB underwent cerclage placement at later gestational ages, had higher rates of exam-indicated cerclage, and were more likely to be prescribed vaginal progesterone. Patients with a TVCL of <2.5 cm after cerclage placement did not have significantly increased odds of sPTB (OR: 2.8, 95% CI: 0.9-8.7, p=0.07); however, patients with a TVCL <2.0 cm had significantly increased odds of sPTB (OR: 6.3, 95% CI: 2.2-18.8, p<0.001).
CONCLUSIONS: In patients with transvaginal cerclage, there does not appear to be increased odds of sPTB with TVCL <2.5 cm after cerclage placement; however, there does appear to be an increased odds of sPTB in patients with a TVCL of <2.0 cm after cerclage placement.
METHODS: This retrospective cohort study included patients with a singleton, non-anomalous gestation with a transvaginal cerclage who had TVCL surveillance post-cerclage placement. The primary outcome was the odds of sPTB among patients with TVCL <2.5 cm vs TVCL ≥2.5 cm after cerclage placement. Transvaginal cerclage placement indications included history indicated, physical exam indicated, and ultrasound indicated. Outcomes were assessed using univariate and multivariate analysis while adjusting for progesterone use, TVCL before cerclage placement, and cerclage indication.
RESULTS: The analysis included 210 patients, and the sPTB rate was 46.7%. Those with sPTB underwent cerclage placement at later gestational ages, had higher rates of exam-indicated cerclage, and were more likely to be prescribed vaginal progesterone. Patients with a TVCL of <2.5 cm after cerclage placement did not have significantly increased odds of sPTB (OR: 2.8, 95% CI: 0.9-8.7, p=0.07); however, patients with a TVCL <2.0 cm had significantly increased odds of sPTB (OR: 6.3, 95% CI: 2.2-18.8, p<0.001).
CONCLUSIONS: In patients with transvaginal cerclage, there does not appear to be increased odds of sPTB with TVCL <2.5 cm after cerclage placement; however, there does appear to be an increased odds of sPTB in patients with a TVCL of <2.0 cm after cerclage placement.
摘要：
背景：经阴道宫颈长度（TVCL）监测经阴道环扎术后并未普遍进行，尽管短TVCL与自发性早产（sPTB）的风险相关。这项研究评估了环扎放置后TVCL<2.5cm的患者sPTB的几率是否高于环扎放置后TVCL≥2.5cm的患者。
方法：这项回顾性队列研究包括单例患者，经阴道环扎术后进行TVCL监测的非异常妊娠。主要结果是环扎术后TVCL<2.5cm与TVCL≥2.5cm患者发生sPTB的几率。经阴道环扎术的适应症包括病史，体检表明，和超声指示。使用单变量和多变量分析评估结果，同时调整孕酮的使用，环扎放置前的TVCL,和环扎适应症。
结果：分析包括210例患者，sPTB率为46.7%。患有sPTB的人在以后的胎龄接受环扎术，检查指示的环扎率较高，并且更有可能服用阴道孕酮。环扎后TVCL<2.5cm的患者sPTB的几率没有明显增加(OR:2.8,95%CI:0.9-8.7,p=0.07);TVCL<2.0cm的患者出现sPTB的几率显著增加(OR:6.3,95%CI:2.2~18.8,p<0.001).
结论：在经阴道环扎术的患者中，环扎放置后TVCL<2.5cm的sPTB的几率似乎没有增加；然而，在TVCL<2.0cm的患者中,环扎后sPTB的几率确实增加.
方法：这项回顾性队列研究包括单例患者，经阴道环扎术后进行TVCL监测的非异常妊娠。主要结果是环扎术后TVCL<2.5cm与TVCL≥2.5cm患者发生sPTB的几率。经阴道环扎术的适应症包括病史，体检表明，和超声指示。使用单变量和多变量分析评估结果，同时调整孕酮的使用，环扎放置前的TVCL,和环扎适应症。
结果：分析包括210例患者，sPTB率为46.7%。患有sPTB的人在以后的胎龄接受环扎术，检查指示的环扎率较高，并且更有可能服用阴道孕酮。环扎后TVCL<2.5cm的患者sPTB的几率没有明显增加(OR:2.8,95%CI:0.9-8.7,p=0.07);TVCL<2.0cm的患者出现sPTB的几率显著增加(OR:6.3,95%CI:2.2~18.8,p<0.001).
结论：在经阴道环扎术的患者中，环扎放置后TVCL<2.5cm的sPTB的几率似乎没有增加；然而，在TVCL<2.0cm的患者中,环扎后sPTB的几率确实增加.
