McDonald环扎术治疗宫颈缩短单胎妊娠早产的疗效  

Efficacy of McDonald cerclage in the treatment of premature delivery in singleton pregnancies with cervical shortening

作　　者：王俊 陈奕 Wang Jun;Chen Yi(Department of Obstetrics and Gynecology,Beijing Obstetrics and Gynecology Hospital Affiliated of Capital Medical University/Beijing Maternal and Child Health Care Hospital,Beijing 100026;Department of Obstetrics and Gynecology,Huairou District Maternal and Child Health Hospital,Beijing 101400,P.R.China)

机构地区：[1]首都医科大学附属北京妇产医院/北京妇幼保健院妇产科,北京100026 [2]北京市怀柔区妇幼保健院妇产科,北京101400

出　　处：《中国计划生育和妇产科》2025年第3期67-71,共5页Chinese Journal of Family Planning & Gynecotokology

摘　　要：目的探讨McDonald环扎术对单胎妊娠宫颈缩短患者的疗效。方法收集2019年1月至2022年12月于北京妇产医院产检并分娩、孕期动态监测宫颈长度(cervical length,CL)缩短的382例无症状单胎孕妇病例资料进行回顾性分析。根据有无晚期自然流产或早产病史(本文中简称病史)及采取干预措施前超声测量的CL分为四个组:a组为有病史且CL≥25 mm;b组为有病史且CL<25 mm;c组为无病史但10 mm≤CL<25 mm;d组为无病史但CL<10 mm,各组根据是否环扎又分为环扎与未环扎两个亚组。比较各组内环扎与未环扎组的一般资料及围产结局,主要结局指标是34周前早产率及活婴获得率。结果(1)各组内环扎组与未环扎组年龄、孕前体质量指数、宫颈手术史、初产、辅助生殖助孕等一般资料比较均无统计学差异(P>0.05);(2)a组、c组内环扎组与未环扎组围产结局比较,差异均无统计学意义(P>0.05);b组、d组内环扎组与未环扎组围产结局比较,差异均有统计学意义(P<0.05)。结论对于无症状单胎孕妇,有病史且CL≥25 mm或者无病史但10 mm≤CL<25 mm的情况下手术获益并不明显,不能明显改善围产结局。Objective To evaluate the efficacy of McDonald cerclage in singleton pregnancies with cervical shortening.Methods A retrospective analysis was conducted on 382 asymptomatic singleton pregnant women who underwent prenatal care and delivery at Beijing Obstetrics and Gynecology Hospital between January 2019 and December 2022,with dynamic monitoring of cervical length(CL)showing shortening during pregnancy.Based on the presence or absence of a history of late spontaneous abortion or preterm birth(referred to as"history"in this study)and the CL measured by ultrasound before intervention,the patients were divided into four groups:Group a(with history and CL≥25 mm),Group b(with history and CL<25 mm),Group c(without history but 10 mm≤CL<25 mm),and Group d(without history but CL<10 mm).Each group was further divided into subgroups based on whether cerclage was performed(cerclage vs.non-cerclage).General characteristics and perinatal outcomes were compared between the cerclage and non-cerclage subgroups within each group.The primary outcome measures were the rate of preterm birth before 34 weeks and the rate of live births.Results(1)There were no statistically significant differences in general characteristics such as age,pre-pregnancy BMI,history of cervical surgery,primiparity,or assisted reproductive technology between the cerclage and non-cerclage subgroups within each group(P>0.05).(2)No significant differences in perinatal outcomes were observed between the cerclage and non-cerclage subgroups in Group a and Group c(P>0.05).However,significant differences were found in Group b and Group d(P<0.05).Conclusion For asymptomatic singleton pregnant women,McDonald cerclage does not significantly improve perinatal outcomes in cases with a history of late spontaneous abortion or preterm birth and CL≥25 mm,or in cases without a history but with 10 mm≤CL<25 mm.

关 键 词：McDonald环扎术 宫颈缩短 单胎妊娠 早产 围产结局 

分 类 号：R714.46[医药卫生—妇产科学] R714.461[医药卫生—临床医学]