双胎妊娠中期宫颈明显进展行宫颈环扎术的妊娠结局  

Cervical cerclage for progressive cervical dilation in the second trimester of twin pregnancy

作　　者：李佳慧 张曦文[1] 王敏[1] 崔君泽 周海燕[1] 郭冉冉 杨淑莉[1] LI Jiahui;ZHANG Xiwen;WANG Min;CUI Junze;ZHOU Haiyan;GUO Ranran;YANG Shuli(Department of Gynecology and Obstetrics,The Second Hospital of Jilin University,Changchun,Jilin 130000,China)

机构地区：[1]吉林大学第二医院妇产科,吉林长春130000

出　　处：《中国临床研究》2023年第8期1210-1213,共4页Chinese Journal of Clinical Research

基　　金：吉林省卫生专项项目(2020SCZT078)。

摘　　要：目的比较双胎妊娠孕中期出现宫颈过短或宫颈明显扩张患者行不同治疗方式的母婴结局。方法回顾性选取2016年1月至2022年2月就诊于吉林大学第二医院产科因孕中期出现宫颈过短或宫颈明显扩张的双胎妊娠患者,其中行经阴道McDonald式子宫颈环扎术12例为A组;行保守治疗21例为B组,观察两组临床特征及妊娠结局。结果A组患者相比于B组,延长孕周增加[(9.5±4.0)周vs(4.6±4.3)周,t=3.287,P<0.01];胎膜早破的发生率增加(50.0%vs 14.3%,P<0.05);发生新生儿窒息的风险明显降低(4.2%vs 38.1%,P<0.01);新生儿存活率增加(91.7%vs 52.4%,P<0.05);<28周分娩率(16.7%vs 57.1%,P<0.05)降低。且联合使用阿托西班的A组7例患者与B组13例患者相比,孕周延长[(9.1±3.7)周vs(4.1±4.8)周,P<0.05]。结论对于宫颈长度<15 mm或宫颈扩张>10 mm的双胎妊娠中期患者,行宫颈环扎术能降低新生儿窒息风险,提高新生儿存活率。宫颈环扎术联合使用阿托西班者孕周明显延长。Objective To evaluate the maternal and infant outcomes of different cerclage techniques for the patients with short cervix or obvious cervical dilation in the second trimester of twin pregnancy.Methods Women with twin pregnancies and cervical shortening or dilating in the second trimester of pregnancy were retrospectively selected,who were treated in the Second Hospital of Jilin University from January 2016 to February 2022.McDonald transvaginal cervical cerclage was conducted in 12 cases(group A)and conservative treatment was given in 21 cases(group B).The clinical features and pregnancy outcomes were observed in two groups.Results The extend gestational age in group A was significantly longer than that in group B[(9.5±4.0)weeks vs(4.6±4.3)weeks,t=3.287,P<0.01].The incidence of premature rupture of membranes significantly increased in group A compared with group B(50.0%vs 14.3%,P<0.05).Compared with those in group B,the risk of neonatal asphyxia was significantly reduced(4.2%vs 38.1%,P<0.01),the neonatal survival rate increased(91.7%vs 52.4%,P<0.05),and the delivery rate at less than 28 weeks decreased(16.7%vs 57.1%,P<0.05)in group A.Compared with 13 patients in group B,7 patients in group A who used atoxiban in combination showed an increase in gestational age[(9.1±3.7)weeks vs(4.1±4.8)weeks,P<0.05].Conclusion For the patients with cervical length<15 mm or cervical dilation>10 mm in the second trimester of twin pregnancy,cervical cerclage can reduce the risk of neonatal asphyxia and improve neonatal survival rate.The gestational age can be prolonged with the combination of atoxiban and cervical cerclage.

关 键 词：宫颈环扎术 宫颈机能不全 妊娠结局 早产 宫缩抑制剂 胎膜早破 新生儿窒息 双胎妊娠 

分 类 号：R714.23[医药卫生—妇产科学]