目的:探讨经阴道环扎术治疗双胎妊娠宫颈缩短的疗效。并缩小经阴道环扎术的阈值宫颈长度。
方法:这是一项前瞻性队列研究,包括177例双胎妊娠,在妊娠16+0至25+6周期间,无症状宫颈扩张或宫颈长度小于或等于15mm。在咨询了经阴道环扎的风险和潜在益处后,患者独立选择了经阴道环扎(n=129)或不进行环扎治疗(n=48)。主要结局指标是分娩时的胎龄和新生儿存活率。
结果:与无环扎组相比,环扎组在分娩时孕龄较高(32.1±4.5vs28.3±6.2周,P<0.001)和更高的新生儿存活率(86.4%vs47.9%,P<0.001)。亚组分析显示,在宫颈扩张或宫颈长度小于10毫米的双胎妊娠中,环扎组分娩时孕龄明显较高(31.3±4.6vs23.4±4.3周,P<0.001)和更高的新生儿存活率(123[85.4%]vs4[9.1%],P<0.001)比无环扎组,但是在子宫颈长度为10-15毫米的双胞胎中,两组之间的两项测量相似。
结论:当宫颈扩张或宫颈长度小于10毫米时,经阴道环扎术可能对双胞胎有益。但是当子宫颈长度为10-15毫米时,其功效可能无法扩展到双胞胎。需要进一步的证据来证实经阴道环扎术对子宫颈短的双胎妊娠的疗效。
OBJECTIVE: To investigate the efficacy of transvaginal cerclage in twin pregnancies with cervical shortening, and to narrow the threshold cervical length for transvaginal cerclage.
METHODS: This is a prospective cohort study and 177 twin pregnancies with asymptomatic cervical dilatation or cervical length of 15 mm or less between 16+0 and 25+6 weeks of pregnancy were included. Patients independently chose either transvaginal cerclage (n = 129) or no cerclage treatment (n = 48) after being consulted on the risk and potential benefit of transvaginal cerclage. The primary outcome measures were gestational age at delivery and neonatal survival rate.
RESULTS: Compared with the no cerclage group, the cerclage group exhibited a higher gestational age at delivery (32.1 ± 4.5 vs 28.3 ± 6.2 weeks, P < 0.001) and a higher neonatal survival rate (86.4% vs 47.9%, P < 0.001). Subgroup analysis showed that in twin pregnancies with cervical dilatation or cervical length less than 10 mm, the cerclage group had significantly higher gestational age at delivery (31.3 ± 4.6 vs 23.4 ± 4.3 weeks, P < 0.001) and a higher neonatal survival rate (123 [85.4%] vs 4 [9.1%], P < 0.001) than the no cerclage group, but in twins when cervical length was 10-15 mm, the two measures were similar between the two groups.
CONCLUSIONS: Transvaginal cerclage may provide benefits for twins when cervical dilatation or cervical length is less than 10 mm, but its efficacy might not extend to twins when the cervical length is 10-15 mm. Further evidence is needed to confirm the efficacy of transvaginal cerclage for twin pregnancies with a short cervix.