Clinical outcomes and influencing factors of different treatment for singleton pregnancies with short cervix before 24 weeks of gestation
Objective To investigate the clinical outcomes and influencing factors of different treatment for singleton pregnancies with short cervix before 24 weeks of gestation.Methods Clinical data of 86 singleton pregnant women with short cervix(≤25 mm)before 24 weeks of gestation who underwent prenatal examination or hospitalization at Wenzhou People's Hospital from January 2020 to December 2022 were retrospectively analyzed.According to cervical length,the pregnant women were divided into ≤10 mm group(n=24),>10-20 mm group(n=24)and>20-25 mm group(n=38).Each group was further divided into control group(progesterone only),cervical cerclage group(progesterone combined with cervical cerclage),pessary+cervical cerclage group(progesterone combined with pessary+cervical cerclage)according to different treatments.The pregnancy outcomes in pregnant women with different treatment in different cervical length groups were compared,and the influencing factors of premature delivery before 24 weeks of pregnancy were analyzed by multivariate logistic regression analysis.Results In the cervical length ≤10 mm group,cervical cerclage group and pessary+cervical cerclage group had longer pregnancy extension time,gestational weeks of delivery,heavier neonatal weight,lower delivery rate<28 weeks and<34 weeks,lower neonatal mortality and incidence of adverse neonatal outcomes than those in control groups(all P<0.05);while there was no significant difference in above indicators between cervical cerclage group and pessary+cervical cerclage group(all P>0.05).In the cervical length>10-20 mm group,neonatal mortality in cervical cerclage group and pessary+cervical cerclage group was lower than that in control group(both P<0.05),and amniotic infection rate in cervical cerclage group was higher than that in control group and pessary+cervical cerclage group(both P<0.05).The weight of newborns in pessary+cervical cerclage group was higher than that in control group and cervical cervix group(both P<0.05).There were no significant differences in pregnancy extension time,gestational week,proportion of deliveries<28,34,37 weeks and adverse neonatal outcomes among the three treatment groups(all P>0.05).In the cervical length>20-25 mm group,there was no significant difference in pregnancy outcome among the three treatment groups(all P>0.05).Cervical length(OR=0.919,P=0.016)was an independent protective factor for preterm labor in women with short cervix before 24 weeks of gestation,while intraamniotic infection(OR=7.064,P<0.001)was an independent risk factor for preterm labor in women with short cervix before 24 weeks of gestation.Conclusion Cervical length was an independent protective factor for preterm labor in women with short cervix before 24 weeks of gestation,while intraamniotic infection was an independent risk factor.Cervical cerclage or pessary plus cervical cerclage before 24 weeks of gestation can improve pregnancy outcomes,and there is no significant difference between the two treatment methods;while for singleton pregnant women with cervical length>10 mm,there is no significant difference for different treatment methods.