摘要
目的探讨单胎妊娠24周前短宫颈孕妇不同治疗方式妊娠结局及早产影响因素。方法回顾性选取2020年1月至2022年12月在温州市人民医院接受产前检查或住院,妊娠24周前经阴道或会阴超声测量宫颈长度≤25 mm并接受孕激素治疗的86例单胎孕妇为研究对象。根据宫颈长度分为≤10 mm组24例、>10~20 mm组24例、>20~25 mm组38例,每组根据治疗方式不同又分为对照组(仅黄体酮软胶囊治疗)、宫颈环扎组(黄体酮软胶囊联合宫颈环扎术治疗)、子宫托+宫颈环扎组(黄体酮软胶囊联合子宫托+宫颈环扎术治疗);比较相同宫颈长度组内3种治疗方式孕妇妊娠结局及新生儿结局,采用多因素logistic回归分析妊娠24周前短宫颈孕妇早产的影响因素。结果在宫颈长度≤10 mm组内,宫颈环扎组、子宫托+宫颈环扎组妊娠延长时间、分娩孕周以及新生儿体重均大于对照组(均P<0.05),<28周分娩比例以及新生儿死亡率均低于对照组(均P<0.05);但宫颈环扎组与子宫托+宫颈环扎组妊娠结局及新生儿结局比较差异均无统计学意义(均P>0.05)。在宫颈长度>10~20 mm组内,宫颈环扎组、子宫托+宫颈环扎组新生儿死亡率均低于对照组(均P<0.05),宫颈环扎组羊膜腔感染率高于对照组、子宫托+宫颈环扎组(均P<0.05),子宫托+宫颈环扎组新生儿体重均大于对照组、宫颈环扎组(均P<0.05);3种治疗方式妊娠延长时间,分娩孕周,<28、34、37周分娩比例以及新生儿不良结局比较差异均无统计学意义(均P>0.05)。在宫颈长度>20~25 mm组内,3种治疗方式孕妇妊娠结局及新生儿结局比较差异均无统计学意义(均P>0.05)。宫颈长度(OR=0.919,P=0.016)是妊娠24周前短宫颈孕妇早产的独立保护因素,羊膜腔感染(OR=7.064,P<0.001)是妊娠24周前短宫颈孕妇早产的独立危险因素。结论宫颈长度是妊娠24周前短宫颈孕妇早产的独立保护因素,羊膜腔感染是独立危险因素。妊娠24周前宫颈长度≤10 mm的单胎孕妇采用宫颈环扎术或子宫托+宫颈环扎术能改善妊娠结局及新生儿结局,而宫颈长度>10 mm的单胎孕妇,不同治疗方式对妊娠结局及新生儿结局影响不大。
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.
作者
周飞飞
胡艳君
郑建琼
ZHOU Feifei;HU Yanjun;ZHENG Jianqiong(Department of Obstetrics and Gynecology,Wenzhou People's Hospital(Wenzhou Maternal and Child Health Care Hospital),Wenzhou 325000,China)
出处
《浙江医学》
CAS
2024年第11期1157-1162,共6页
Zhejiang Medical Journal
基金
温州市基础性科研项目(Y2020499)。
关键词
宫颈环扎
子宫托
短宫颈
早产
单胎妊娠
Cervical cerclage
Pessary
Short cervix
Preterm labor
Singleton pregnancy
