Effects of different surgical methods in the treatment of cervical incompetence in non-pregnant women of childbearing age and pregnant women in the second trimester

doi:10.3877/cma.j.issn.1673-5250.2022.02.006

Objective

To investigate clinical efficacy and pregnancy outcomes between patients with cervical incompetence (CI) of non-pregnant women of childbearing age underwent laparoscopic abdominal cervical cerclage (LAC), and of pregnant women in the second trimester (12-16 gestational weeks) underwent transvaginal cervical cerclage (TVC).

Methods

A total of 171 patients with CI who planned to undergo cervical cerclage (CC) from August 2016 to June 2020 in Chengdu Women′s and Children′s Central Hospital were selected as research subjects. According to whether CI patients were pregnant or not during CC treatment, they were divided into research group (n=118, non-pregnant women of childbearing age who received LAC) and control group (n=53, pregnant women who received TVC in the second-trimester). Clinical data, including successful rate of CC treatment (≥28 gestational weeks deliver), rate of ≥34 gestational weeks deliver, miscarriage rate, neonatal birth weight and surgery-related indicators between two groups were analyzed by prospective cohort study method and compared by independent-samples t test and chi-square test. The procedures followed in this study were in line with the requirements of newly revised World Medical Association Helsinki Declaration in 2013, and informed consent for clinical study was signed with all subjects enrolled in this study. There were no significant differences among clinical data of age, gravidity, times of abortion, gestational weeks at abortion, diameter of cervical internal os and length of cervix between two groups (P>0.05).

Results

①Average operation duration and volume of intraoperative blood loss of TVC in CI patients of research group were significantly longer or more than those in control group, and differences were statistically significant (t=9.742, Z=-9.463; both P<0.001). There was no statistical difference in hospitalization time between two groups (P>0.05). There were no complications during operation and postoperation between two groups, and all patients were discharged after operation. ②The overall successful rate of CC treatment between two groups after CC treatment was 90.6% (155/171). The successful rate of CC treatment, rates of term delivery (≥37 gestational weeks deliver), ≥34 gestational weeks deliver, and miscarriage, gestational age at deliver and neonatal birth weight in research group were all better than those in control group, and all differences were statistically significant (χ²=8.192, 10.858, 9.319, 8.192; t=3.452, 4.823; all P<0.05). There was no significant difference in rate of preterm birth (>28-37 gestational weeks deliver) between two groups (P>0.05).

Conclusions

Clinical curative effect of LAC that non-pregnant women with CI of childbearing age underwent is much better than that of TVC in pregnant women with CI in the second trimester. However, average operation duration and volume of intraoperative blood loss of TVC in pregnant women with CI in the second trimester were shorter and less, and vaginal delivery was available. LAC and TVC for treatment of CI patients have their own advantages, it is important to target CI patients to choice individual treatment schemes.

Key words: Uterine cervical incompetence, Cerclage, cervical, Laparoscopes, Laparoscopic cervical cerclage, Transvaginal cervical cerclage, Blood loss, surgical, Female, childbearing age, Pregnant women

表1 2组CI患者一般临床资料比较(±s)

组别	例数	年龄(岁)	孕次(次)	流产次数(次)	流产时孕龄(周)	宫颈内口宽度(cm)	宫颈长度(cm)
研究组	118	29.4±3.6	2.9±1.0	2.0±0.9	23.8±2.2	0.9±0.3	3.0±0.7
对照组	53	28.3±4.2	2.6±1.0	2.1±0.9	23.3±3.7	0.9±0.2	2.8±0.7
t值		1.464	1.823	1.812	1.141	0.212	1.533
P值		0.151	0.071	0.062	0.261	0.943	0.132

表1 2组CI患者一般临床资料比较(±s)

组别	例数	年龄(岁)	孕次(次)	流产次数(次)	流产时孕龄(周)	宫颈内口宽度(cm)	宫颈长度(cm)
研究组	118	29.4±3.6	2.9±1.0	2.0±0.9	23.8±2.2	0.9±0.3	3.0±0.7
对照组	53	28.3±4.2	2.6±1.0	2.1±0.9	23.3±3.7	0.9±0.2	2.8±0.7
t值		1.464	1.823	1.812	1.141	0.212	1.533
P值		0.151	0.071	0.062	0.261	0.943	0.132

表2 2组CI患者CC治疗的手术持续时间、术中出血量及住院时间比较

组别	例数	手术持续时间(min，±s)^a	术中出血量[mL，M(P₂₅~P₇₅)]	住院时间(d，±s)
研究组	118	37.5±11.6	20(10~30)	3.0±0.5
对照组	53	15.8±3.6	5(4~5)	2.8±0.4
检验值		t＝9.742	Z＝-9.463	t＝1.424
P值		<0.001	<0.001	0.170

表2 2组CI患者CC治疗的手术持续时间、术中出血量及住院时间比较

组别	例数	手术持续时间(min，±s)^a	术中出血量[mL，M(P₂₅~P₇₅)]	住院时间(d，±s)
研究组	118	37.5±11.6	20(10~30)	3.0±0.5
对照组	53	15.8±3.6	5(4~5)	2.8±0.4
检验值		t＝9.742	Z＝-9.463	t＝1.424
P值		<0.001	<0.001	0.170

表3 2组CI患者CC后妊娠结局比较

组别	例数	治疗成功[例数(%)]	足月分娩[例数(%)]	≥34孕周分娩[例数(%)]	早产[例数(%)]	流产[例数(%)]	分娩孕龄(周，±s)	新生儿出生体重(g，±s)
研究组	118	112(94.9)	90(76.3)	109(92.4)	22(18.6)	6(5.1)	36.1±2.7	2 789.0±488.9
对照组	53	43(81.1)	27(50.9)	40(75.5)	16(43.4)	10(18.9)	33.6±4.3	2 271.3±922.8
检验值		χ²＝8.192	χ²＝10.858	χ²＝9.319	χ²＝2.820	χ²＝8.192	t＝3.452	t＝4.823
P值		0.004	0.001	0.002	0.093	0.004	<0.001	<0.001

表3 2组CI患者CC后妊娠结局比较

组别	例数	治疗成功[例数(%)]	足月分娩[例数(%)]	≥34孕周分娩[例数(%)]	早产[例数(%)]	流产[例数(%)]	分娩孕龄(周，±s)	新生儿出生体重(g，±s)
研究组	118	112(94.9)	90(76.3)	109(92.4)	22(18.6)	6(5.1)	36.1±2.7	2 789.0±488.9
对照组	53	43(81.1)	27(50.9)	40(75.5)	16(43.4)	10(18.9)	33.6±4.3	2 271.3±922.8
检验值		χ²＝8.192	χ²＝10.858	χ²＝9.319	χ²＝2.820	χ²＝8.192	t＝3.452	t＝4.823
P值		0.004	0.001	0.002	0.093	0.004	<0.001	<0.001

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