Effect of cervical cerclage on pregnancy outcome in patients with cervical insufficiency in singleton and twin pregnancies
Objective To analyze the pregnancy outcomes of cervical incompetence(CIC)patients undergoing transvaginal cervical cerclage in single and twin pregnancies,and explore the impact of different timing of cerclage on pregnancy outcomes.Methods The clinical data of 186 patients with CIC were retrospectively analyzed.According to the whether or not transvaginal cervical cerclage was done and the different timing of cervical cerclage,they were divided into group of singleton pregnancy with emergency cervical cerclage(30 cases),group of singleton pregnancy with elective cervical cerclage(120 cases),group of single pregnancy without cervical cerclage(dilatation of the uterine orifice at 24-28 weeks of gestation,13 cases),group of twin pregnancy with emergency cervical cerclage(endocervical canal length<15 mm with dialation of the uterine orifice,13 cases),group of twin pregnancy with elective cervical cerclage(endocervical canal length<15 mm with unopened uterine orifice,10 cases).Comparison was made on pregnancy outcomes(postoperative prolonged gestational weeks,gestational weeks of delivery,neonatal survival rate,preterm birth rate,and full-term birth rate)of patients in group of singleton pregnancy with elective cervical cerclage and the group of singleton pregnancy with emergency cervical cerclage with different gestational weeks of cerclage,pregnancy outcomes of patients in group of singleton pregnancy with emergency cervical cerclage and the group of singleton pregnancy without emergency cervical cerclage at 24-28 weeks of gestation,as well as the pregnancy outcomes and gestational weeks of cerclage of of patients in group of twin pregnancy with emergency cervical cerclage and the group of twin pregnancy without emergency cervical cerclage.Results The postoperative prolonged gestational weeks of patients in the group of singleton pregnancy with elective cervical cerclage who were circumcised at 13-18+6,19-23+6,and 24-28 of gestation were 20.45(16.17,22.13),15.30(12.70,19.00),and 12.10(9.45,13.35)weeks,and the preterm birth rates were 35.14%,12.00%,12.00%,and 47.62%.The difference was statistically significant(P<0.05).There was no statistically significant difference in the comparison of gestational weeks of delivery,full-term birth rate,and neonatal survival rate among patients in group of singleton pregnancy with elective cervical cerclage who were circumcised at 13-18+6,19-23+6,and 24-28 weeks of gestation(P>0.05).The postoperative prolonged gestational weeks of patients in group of singleton pregnancy with emergency cervical cerclage who were circumcised at 13-18+6,19-23+6,and 24-28 weeks of gestation were(16.64±9.81),(6.78±5.88),and(9.54±4.31)weeks,the gestational weeks of delivery were(32.76±8.25),(29.01±5.67),and(35.35±3.98)weeks,and the neonatal survival rate were 80.00%,36.36%,and 85.71%.The differences were statistically significant(P<0.05).There was no statistically significant difference in the comparison of full-term birth rate and preterm birth rate among patients in group of singleton pregnancy with emergency cervical cerclage who were circumcised at 13-18+6,19-23+6,and 24-28 weeks of gestation(P>0.05).Compared with the group of singleton pregnancy without cervical cerclage,patients in group of singleton pregnancy with emergency cervical cerclage who were circumcised at 24-28 weeks of gestation had a longer postoperative prolonged gestational weeks,a later gestational week of delivery,a higher neonatal survival rate,a higher full-term birth rate,and a lower preterm birth rate,but the differences were not statistically significant(P>0.05).The postoperative prolonged gestational weeks of patients in group of twin pregnancy with emergency cervical cerclage were shorter than those in the twin pregnancy with elective cervical cerclage,and the difference was statistically significant(P<0.05).There was no statistically significant difference between the group of twin pregnancy with emergency cervical cerclage and the twin pregnancy with elective cervical cerclage when comparing the patients'gestational weeks of delivery,gestational weeks of cerclage,neonatal survival rate,full-term birth rate,and preterm birth rate(P>0.05).Conclusion For pregnant women with dilatation of uterine orifice in single pregnancy,emergency cervical cerclage at 24-28 weeks of gestation can improve the neonatal survival rate;Prophylactic cervical cerclage at 13-18+6 weeks of gestation in singleton pregnancies with high-risk factors is effective in improving pregnancy outcome;Prophylactic cervical cerclage in twin pregnancy with unopened uterine orifice and cervical canal length<15 mm can improve the neonatal survival rate and pregnancy outcome.
Singleton and twin pregnanciesCervical cerclageCervical insufficiencyPregnancy outcome
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