子宫颈长度≤15 mm双胎妊娠孕妇不同孕周行子宫颈环扎术的疗效分析  

Analysis of clinical effect of cervical cerclage in twin pregnancies with cervical length≤15 mm at different gestational ages

作　　者：王丽华[1] 潘勉[1] Wang Lihua;Pan Mian(Department of Obstetrics,Fujian Maternity and Child Health Hospital,Fuzhou 350001,China)

机构地区：[1]福建省妇幼保健院产科,福州350001

出　　处：《中华妇产科杂志》2025年第2期99-104,共6页Chinese Journal of Obstetrics and Gynecology

基　　金：福建省自然科学基金(2021J01406);福建省科技创新联合资金(2020Y9148)。

摘　　要：目的探讨子宫颈长度(CL)≤15 mm双胎妊娠孕妇不同孕周行子宫颈环扎术的临床疗效。方法本研究为回顾性队列研究,纳入2017年1月至2023年12月在福建省妇幼保健院产前检查,妊娠16~27+6周经阴道超声检查提示CL≤15 mm的双胎妊娠孕妇83例,根据治疗方式不同分为子宫颈环扎组(47例)和保守治疗组(36例),并根据CL≤15 mm发现孕周分层(<26周、≥26周),比较两组孕妇妊娠结局的差异。采用多因素logistic回归分析子宫颈环扎术对不同孕周双胎妊娠孕妇早产的影响。结果(1)子宫颈环扎组孕妇分娩孕周、延长孕周均大于保守治疗组(中位分娩孕周分别为35.3、33.0周;中位延长孕周分别为10.4、7.2周),妊娠34、32及28周前早产率均低于保守治疗组[34周前早产率分别为23%(11/47)、53%(19/36);32周前早产率分别为15%(7/47)、39%(14/36);28周前早产率分别为4%(2/47)、25%(9/36)],分别比较,差异均有统计学意义(P均<0.05)。两组孕妇妊娠37周前早产率及未足月胎膜早破率分别比较,差异均无统计学意义(P均>0.05)。(2)CL≤15 mm发现孕周<26周时,子宫颈环扎组的妊娠结局均优于保守治疗组,包括分娩孕周(中位数分别为35.4、31.3周)、延长孕周(中位数分别为11.1、5.6周)、新生儿出生体重[分别为(2246±519)、(1594±691)g]、新生儿不良结局发生率[分别为19%(13/68)、56%(19/34)]、活产率[分别为100%(68/68)、82%(28/34)],分别比较,差异均有统计学意义(P均<0.05)。CL≤15 mm发现孕周≥26周时,两组孕妇妊娠结局比较,差异均无统计学意义(P均>0.05)。(3)多因素logistic回归分析显示,CL≤15 mm发现孕周<26周时,子宫颈环扎术可能降低双胎妊娠孕妇妊娠34周(a OR=0.10,95%CI为0.02~0.51)、32周(a OR=0.11,95%CI为0.02~0.58)、28周(a OR=0.04,95%CI为0.01~0.65)前的早产风险(P均<0.05)。当CL≤15 mm发现孕周≥26周时,子宫颈环扎术均不能降低双胎妊娠孕妇妊娠34、32及28周前的早产风�ObjectiveTo investigate the clinical effect of cervical cerclage at different gestational weeks in twin pregnancy with cervical length(CL)≤15 mm.MethodsThis was a retrospective cohort study.Eighty-three twin pregnant women with CL≤15 mm detected by transvaginal ultrasound at 16-27+6 weeks of gestation in Fujian Maternity and Child Health Hospital from January 2017 to December 2023 were enrolled.According to different treatment methods,they were divided into cervical cerclage group(47 cases)and conservative treatment group(36 cases),and stratified according to the gestational age of CL≤15 mm diagnosis(<26 weeks,≥26 weeks).The differences in pregnancy outcomes between the two groups were compared.Multivariate logistic regression was used to analyze the effect of cervical cerclage on preterm birth in twin pregnant women with different CL≤15 mm diagnosis weeks.Results(1)The gestational age at delivery and prolonged gestational age in the cervical cerclage group were longer than those in the conservative treatment group(median gestational age at delivery:35.3 vs 33.0 weeks;median prolonged gestational age:10.4 vs 7.2 weeks),and preterm birth rates before 34,32 and 28 weeks were lower than those in the conservative treatment group[34 weeks:23%(11/47)vs 53%(19/36);32 weeks:15%(7/47)vs 39%(14/36);28 weeks:4%(2/47)vs 25%(9/36)],the differences were statistically significant(all P<0.05).There were no significant differences in the rates of preterm birth before 37 weeks of gestation and preterm premature rupture of membranes between the two groups(all P>0.05).(2)When gestational age at CL≤15 mm diagnosis was<26 weeks,pregnancy outcomes in the cervical cerclage group were better than those in the conservative treatment group,including gestational age at delivery(median:35.4 vs 31.3 weeks)and prolonged gestational age(median:11.1 vs 5.6 weeks),neonatal birth weight[(2246±519)vs(1594±691)g],incidence of adverse neonatal outcomes[19%(13/68)vs 56%(19/34)],and proportion of live births[100%(68/68)vs 82%(28/34)],resp

关 键 词：妊娠 双胎 环扎术 宫颈 早产 

分 类 号：R713.4[医药卫生—妇产科学]