Effectiveness and influencing factors of transvaginal cervical cerclage for cervical insufficiency / 中华围产医学杂志

ABSTRACT

To evaluate the effectiveness and safety of transvaginal cervical cerclage and to investigate the influencing factors in prognosis. Methods The medical records of 85 cases who underwent transvaginal cervical cerclage in Peking Union Medical College Hospital from January, 1985 to September, 2011 were reviewed. Patients with a typical history of recurrent preterm birth/second trimester miscarriage, or for whom the 8.0 mm Hegar uterine dilator could be pushed through the internal cervical os without resistance during the non-pregnancy period were included in the elective cerclage group (n=69) and those diagnosed as cervical insufficiency during pregnancy were included in the emergency cerclage group (n=16). The numbers of premature birth/second trimester miscarriage, gestational age at cerclage, gestational age at delivery and its influencing factors were compared between the two groups. T test, rank sum test and Fisher's exact test were used for statistical analysis. Results All patients underwent cerclage between 13+3 and 26+6 weeks of gestation without major complications, such as rupture of membrane, placental abruption or bladder injury. Patients in the elective cerclage group underwent the procedure significantly earlier than those in the emergency cerclage group [16.6(15.4, 18.3)vs 22.7(19.5, 24.6)weeks, Z=-5.140, P<0.05]. Nine cases had lost to follow-up. Among the remaining 76 cases, the rate of infection after surgery was 18.4%(14/76);the rate of abortion was 17.1%(13/76); and the rate of live birth was 82.9%(63/76). The live birth rate of the emergency group was lower than that of the elective cerclage group [9/15 vs 88.5%(54/61), Fisher's exact test, P<0.05]. Apparent infection after surgery was observed more frequently in the emergency group than that in the elective cerclage group [6/15 vs 13.1% (8/61), Fisher's exact test, P<0.05]. Uterine malformation, infection after surgery and latent infection befor surgery were unfavorable factors associated with miscarriage and early preterm labor. Conclusions Transvaginal cervical cerclage is a safe and effective treatment for cervical insufficiency. Elective cervical cerclage is superior to emergent cerclage. Emphasis should be placed on the monitoring and treatment of perioperative infection. Cervical cerclage should be undertaken with caution in patients with uterine malformation.