中孕期宫颈功能不全患者施行紧急宫颈环扎术的临床分析

doi:10.3877/cma.j.issn.1673-5250.2016.06.012

目的

探讨中孕期宫颈功能不全(UCI)患者施行紧急宫颈环扎术的临床特点。

方法

选择2014年1月至2015年10月，因UCI于柳州市妇幼保健院施行紧急宫颈环扎术(CC)的16例中孕期患者为研究对象。根据分娩新生儿是否存活，将其分为胎儿未存活组(n＝6)和胎儿存活组(n＝10)。对2组患者的一般临床资料及CC后延长妊娠时间，以及新生儿出生体重及结局等进行回顾性分析。统计学比较2组患者年龄、既往宫腔操作次数、宫颈外口扩张程度、CC时及分娩时孕龄、CC后延长妊娠时间及新生儿出生体重差异。本研究已通过柳州市妇幼保健院伦理委员会的批准。

结果

①本研究16例患者平均年龄为(30.4±4.0)岁，既往宫腔操作次数平均为(2.6±2.4)次，入院时宫颈外口扩张程度为平均为(3.9±2.7) cm，CC时平均孕龄为(22.3±2.2)孕周，分娩时平均孕龄为(29.4±6.3)孕周，CC后延长妊娠时间平均为(49.9±41.6) d，活产新生儿出生体重平均为(2.2±1.0) kg，胎儿分娩后病死率为37.5%(6/16)。②胎儿未存活组患者年龄及既往宫腔操作次数大于或多于胎儿存活组，分娩时孕龄、CC后延长妊娠时间及新生儿出生体重均小于、短于或低于胎儿存活组，且差异均有统计学意义(P<0.05)；2组患者宫颈外口扩张程度及CC时孕龄比较，差异均无统计学意义(P>0.05)。

结论

孕妇年龄及既往宫腔操作次数，可能影响中孕期UCI患者施行紧急CC的妊娠结局。

关键词: 宫颈功能不全, 环扎术，宫颈, 妊娠中期, 妊娠结局, 女性

Objective

To analyze the clinical characteristics of emergency cervical cerclage(CC) for uterine cervical incompetence(UCI) patients in mid-trimester.

Methods

From January 2014 to October 2015, a total of 16 cases of UCI patients in mid-trimester who were underwent emergency CC in Liuzhou Maternity and Child Healthcare Hospital were chosen as study subjects. According to whether the neonatal survived or not, the 16 patients were divided into fetus nonsurvival group(n=6) and fetus survival group(n=10). Retrospectively analyzed the general clinical data and prolongation of pregnancy after CC of all subjects, and the birth weight and outcome of newborns, etc.. The age, the number of previous intrauterine operations, the degree of cervical dilatation, the gestational age at CC and at delivery, the prolongation of pregnancy after CC and the birth weight of the newborns were compared between two groups by statistical method. This study has been approved by the Ethics Committee of Liuzhou Maternal and Child Healthcare Hospital.

Results

①The average age of the 16 patients was (30.4±4.0) years old, the average number of previous intrauterine operations was (2.6±2.4) times, the average cervical dilatation at admission was (3.9±2.7) cm, mean gestational age at CC was (22.3±2.2) weeks and (29.4±6.3) weeks at delivery, the average prolongation of pregnancy after CC was (49.9±41.6) days, the average birth weight of survival newborns was (2.2±1.0) kg, and the fatality rate of fetus after birth was 37.5%(6/16). ②The maternal age and the number of previous intrauterine operations of the nonsurvival group were older or more than those of survival group, while the gestational age at delivery, prolongation of pregnancy after CC and neonatal birth weight were less than those of survival group, and the differences were statistically significant(P<0.05). There were no significant differences between two groups in the degree of cervical dilatation and the gestational age at CC (P>0.05).

Conclusion

Maternal age and the number of previous intrauterine operations may affect the pregnancy outcomes in mid-trimester UCI patients with emergency CC treatment.

Key words: Uterine cervical incompetence, Cerclage, cervical, Pregnancy trimester, second, Pregnancy outcome, Female

表1 2组中孕期宫颈功能不全患者临床特点比较(±s)

组别	例数	年龄(岁)	既往宫腔操作次数(次)	宫颈外口扩张程度(cm)	手术时孕龄(周)	分娩时孕龄(周)	术后延长妊娠时间(d)	新生儿出生体重(kg)
胎儿未存活组	6	33.0±5.2	4.7±2.4	3.1±2.8	21.1±1.7	22.6±2.1	10.5±8.6	0.5±0.1
胎儿存活组	10	28.9±2.2	1.4±1.5	4.4±2.7	23.0±2.2	33.5±3.7	73.6±34.5	2.2±1.0
t值	?	2.22	3.36	－0.90	－1.79	－6.51	－5.51	－5.53
P值	?	0.040	<0.001	0.390	0.100	<0.001	<0.001	<0.001

表1 2组中孕期宫颈功能不全患者临床特点比较(±s)

组别	例数	年龄(岁)	既往宫腔操作次数(次)	宫颈外口扩张程度(cm)	手术时孕龄(周)	分娩时孕龄(周)	术后延长妊娠时间(d)	新生儿出生体重(kg)
胎儿未存活组	6	33.0±5.2	4.7±2.4	3.1±2.8	21.1±1.7	22.6±2.1	10.5±8.6	0.5±0.1
胎儿存活组	10	28.9±2.2	1.4±1.5	4.4±2.7	23.0±2.2	33.5±3.7	73.6±34.5	2.2±1.0
t值	?	2.22	3.36	－0.90	－1.79	－6.51	－5.51	－5.53
P值	?	0.040	<0.001	0.390	0.100	<0.001	<0.001	<0.001

[1]	祝丽琼，张建平，陈少青. 三种时机宫颈环扎术的临床对比研究[J]. 生殖医学杂志，2009，18(3)：269-271.
[2]	Stupin JH, David M, Siedentopf JP, et al. Emergency cerclage versus bed rest for amniotic sac prolapse before 27 gestational weeks: a retrospective, comparative study of 161 women[J]. Eur J Obstet Gynecol Reprod Biol，2008，139(1)：32-37.
[3]	Debby A, Sadan O, Glezerman M, et al. Favorable outcome following emergency second trimester cerclage[J]. Int J Gynaecol Obstet，2007，96(1)：16-19.
[4]	Daskalakis G, Papantoniou N, Mesogitis S, et al. Management of cervical insufficiency and bulging fetal membranes[J]. Obstet Gynecol，2006，107(2 Pt 1)：221-226.
[5]	张晶，周欣，张国英，等. 紧急宫颈环扎术配伍盐酸利托君治疗难治性宫颈机能不全性晚期流产临床分析[J]. 南京医科大学学报：自然科学版，2014，34(2)：214-216.
[6]	Lee SM, Park KH, Jung EY, et al. Prediction of spontaneous preterm birth in women with cervical insufficiency: comprehensive analysis of multiple proteins in amniotic fluid[J]. J Obstet Gynaecol Res，2016，42(7)：776-783.
[7]	Ciavattini A, Delli CG, Boscarato V, et al. Effectiveness of emergency cerclage in cervical insufficiency[J]. J Matern Fetal Neonatal Med，2016，29(13)：2088-2092.
[8]	Gedikbasi A, Yücel B, Arslan O, et al. Dynamic collagen changes in cervix during the first trimester and decreased collagen content in cervical insufficiency[J]. J Matern Fetal Neonatal Med，2016，29(18)：2968-2972.
[9]	Alsulmi E, Schneider C. Cervical insufficiency and cervical cerclage[J]. J Obstet Gynaecol Can，2014，36(10)：862.
[10]	Jackson M. What is new in cervical insufficiency? Best articles from the past years[J]. Obstet Gynecol，2016，127(3)：598-599.
[11]	American College of Obstetricians and Gynecologists.ACOG Practice Bulletin No.142: cerclage for the management of cervical insufficiency[J]. Obstet Gynecol，2014，123(2 Pt 1)：372-379.
[12]	Roman A, Suhag A, Berghella V. Overview of cervical insufficiency: diagnosis，etiologies，and risk factors[J]．Clin Obstet Gynecol, 2016，59(2)：237-240.
[13]	Shah PS, Zao J. Knowledge synthesis group on determinants of preterm/LBW births. Induced termination of pregnancy and low birth weight and preterm birth：a systematic review and meta-analysis[J]. BJOG，2009，116(11)：1425-1442.
[14]	Vyas NA, Vink JS, Ghidini A, et al. Risk factors for cervical insufficiency after term delivery[J]. Am J Obstet Gynecol，2006，195(3)：787-791.
[15]	D′Agostini C, de Oliveira M, D′Souza-Li L. Comparison of cervical length in adult and adolescent nulliparae at mid-gestation[J]. J Pediatr Adolesc Gynecol，2013，26(4)：209-211.

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Clinical investigation of emergency cervical cerclage for uterine cervical incompetence patients in mid-trimester

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Clinical investigation of emergency cervical cerclage for uterine cervical incompetence patients in mid-trimester