孕中期短子宫颈双胎孕妇实施子宫颈环扎术的疗效评估  

The Efficacy of Cervical Cerclage in Twin Pregnant Women with Short Cervix in the Second Trimester

作　　者：姚莉萍 杨清 胡晶晶 陈智勤 裴锦丹 伍岳琳 周晨晨 YAO Liping;YANG Qing;HU Jingjing(Department of Ultrasound,Shanghai Key Laboratory of Maternal Fetal Medicine,Shanghai First Maternity and Infant Hospital,School of Medicine,Tongji University,Shanghai 200092,China)

机构地区：[1]同济大学附属第一妇婴保健院上海市母胎医学重点实验室超声科,上海201204 [2]同济大学附属第一妇婴保健院上海市母胎医学重点实验室生殖中心,上海201204 [3]同济大学附属第一妇婴保健院上海市母胎医学重点实验室产科,上海201204

出　　处：《实用妇产科杂志》2022年第10期779-784,共6页Journal of Practical Obstetrics and Gynecology

摘　　要：目的:探讨孕24周前超声诊断子宫颈短而无临产症状且无早产史的双胎妊娠孕妇,进行子宫颈环扎术能否降低早产发生率。方法:回顾性分析130例孕24周前阴道超声检查发现子宫颈长度(CL)≤25 mm,无临产症状且无早产史的双胎妊娠孕妇,按照有无实施McDonald子宫颈环扎术分为环扎组(80例)和非环扎组(50例)。观察两组分别在孕周<37周、<34周、<32周、<28周早产发生率和新生儿结局[围产期死亡率、低出生体质量和入住新生儿重症监护室(NICU)的发生率]。通过Logistic回归分析<34周早产发生的影响因素。分成CL≤15 mm和CL>15 mm两个亚组,分别进行组间早产率、新生儿结局比较。结果:环扎组与非环扎组在孕周<37周、<34周、<32周和<28周的早产发生率、新生儿出生体质量、低出生体质量、入NICU比例差异无统计学意义(P>0.05)。环扎组新生儿围产期死亡率较非环扎组显著降低(P<0.05)。Logistic回归分析显示环扎与否和CL是发生早产<34周的影响因素(P<0.05)。在CL≤15 mm亚组中,环扎组早产<34周的发生率、低出生体质量、极低出生体质量和入NICU发生率均显著低于非环扎组,且差异有统计学意义(P<0.05)。在CL>15 mm的亚组中,环扎组和非环扎组间早产发生率和新生儿结局差异无统计学意义(P>0.05)。结论:子宫颈环扎术对CL>15 mm的无症状短子宫颈双胎孕妇并不能改善其早产率;而对CL≤15 mm的双胎孕妇可显著降低早产率及改善新生儿结局。Objective:To investigate whether cervical cerclage diagnosed by ultrasound can reduce the rate of preterm birth(PTB)in asymptomatic twin-pregnant women before 24 gestational weeks.Methods:In this retrospective cohort study of asymptomatic twin-pregnant women with cervical length(CL)≤25 mm before 24 gestational weeks,130 cases were divided into cerclage group(n=80)and non-cerclage group(n=50)according to cerclage performance.PTB rates(<37 weeks,<34 weeks,<32 weeks,<28 weeks)and neonatal outcomes(perinatal mortality,birth weight,and NICU admission rate)were observed between the two groups.The preterm birth rates and neonatal outcomes were compared among CL≤15 mm and CL>15 mm subgroups by Logistic regression analysis.Results:There were no significant differences in PTB rates(<37 weeks,<34 weeks,<32 weeks,<28 weeks),neonatal birth weight,low birth weight and NICU admission rate between the two groups(P>0.05).The perinatal mortality of neonates in the cerclage group was significantly lower than that in the non-cerclage group(P<0.05).Logistic regression analysis showed that whether cerclage or not and CL were the influencing factors for PTB<34 weeks(P<0.05).In the CL≤15 mm subgroup analysis,PTB<34 weeks was lower in cerclage group than that in non-cerclage group(P<0.05).There were no significant difference in the incidence of PTB and neonatal outcomes between the two groups under CL>15 mm subgroup analysis(P>0.05).Conclusions:Cervical cerclage in asymptomatic twin-pregnant women with short cervix(CL>15 mm)does not effect the rate of PTB or the neonatal outcome.For twin-pregnant women with very short cervix(CL≤15 mm),cerclage can significantly reduce the rate of PTB and improve the neonatal outcomes.

关 键 词：双胎妊娠 子宫颈环扎术 早产 超声 子宫颈长度 

分 类 号：R713.4[医药卫生—妇产科学]