Comparison of the clinical effect of laparoscopic cervical cerclage in the treatment of cervical insufficiency during pregnancy and before pregnancy
Objective To compare the clinical effect of laparoscopic cervical cerclage during pregnancy and before pregnancy in patients with cervical insufficiency.Methods A retrospective analysis was performed on 100 patients who were diagnosed with cervical insufficiency and underwent laparoscopic cervical cerclage by Professor Ying Xiaoyan's team in the Second Affiliated Hospital of Nanjing Medical University from January 2020 to August 2022.Among them,69 cases underwent laparoscopic cervical cerclage during pregnancy(pregnancy group)and 31 cases underwent laparoscopic cervical cerclage before pregnancy(pre-pregnancy group).The general data,surgical indicators,pregnancy outcomes and complications of the two groups were summarized and analyzed.The pregnant group was further divided into＜14 weeks[mean(12.17±1.23)weeks,47 cases]and ≥14 weeks[mean(16.42±2.42)weeks,22 cases]according to the gestational age.The surgical indicators and pregnancy outcomes were compared between the two groups.Results There were no complications such as bladder injury and massive hemorrhage during cerclage in the two groups.After follow-up,31 patients in the pre-pregnancy group were successfully pregnant within 1 year after surgery.The length of hospital stay in the pre-pregnancy group was shorter than that in the pregnancy group,the difference was statistically significant(P＜0.05).The number of tocolysis during pregnancy in the pre-pregnancy group was less than that in the pregnancy group,the gestational age at delivery was longer than that in the pregnancy group,and the full-term rate,neonatal weight and neonatal 1 minute Apgar score were higher than those in the pregnancy group,and the differences were statistically significant(P＜0.05).There was no significant difference in live birth rate between the pre-pregnancy group(93.5％)and the pregnancy group(92.8％).In the pregnant group,there was no significant difference in the number of pregnancy preservation,gestational age at delivery,full-term rate,live birth rate,neonatal weight,neonatal 1 minute Apgar score and neonatal transfer rate between the patients with gestational age ≥14 weeks and those with gestational age＜14 weeks(P＞0.05).Conclusions The application of laparoscopic cervical cerclage before pregnancy in patients with cervical insufficiency has a significant effect,which can effectively reduce the incidence of preterm birth,prolong the gestational age,improve the delivery outcome and the quality of perinatal infants,which is worthy of clinical promotion.Laparoscopic cervical cerclage can be considered as a treatment option for patients with gestational age≥14 weeks who need prophylactic cerclage.
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