孕前腹腔镜宫颈环切术预防中期妊娠丢失和早产:一项为期6年的研究

IF 1.5 Q3 OBSTETRICS & GYNECOLOGY
Niraj Yanamandra, Swapna Pooskuru
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引用次数: 0

摘要

目的评价孕前腹腔镜宫颈环切术(LCC)治疗宫颈功能不全的手术效果和妊娠结局。研究设计:我们对连续发生孕前LCC的女性进行了一项观察性研究。前瞻性收集了55名在2017年1月至2021年12月期间因宫颈功能不全而存在妊娠中期流产和极端早产高风险的妇女的数据。这包括患者人口统计和相关的产科;妇科病史,既往宫颈环切,手术并发症和随后的妊娠结局。所有参与研究的女性都至少有过一次不成功的经阴道宫颈环切术。手术在印度海得拉巴的私立三级医院进行。后续工作一直持续到2022年12月。主要终点是新生儿存活率。同时记录手术并发症及发病率。结果49例妊娠,46例妊娠超过妊娠早期。4.34%(2/46)因早产胎膜早破(PPROM)在28 ~ 33周分娩。13.04%(6/46),包括5例妊娠并发症和1例独角子宫,需要在34 ~ 36周分娩。82.60%(38/46)的妇女在妊娠37周或37周以上分娩。在妊娠超过三个月的妇女中,活产率和新生儿存活率为100%。所有新生儿预后良好,无长期发病率。术中及术后均无直接并发症。两名妇女有长期并发症,以胶带糜烂的形式需要进一步手术。结论本研究提供的证据表明,LCC可显著改善宫颈无力患者的妊娠结局,且不增加安全风险。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Preconception laparoscopic cervical cerclage for prevention of mid-trimester pregnancy loss and preterm birth: A 6-year study

Objective

To evaluate surgical results and pregnancy outcomes of preconception laparoscopic cervical cerclage (LCC) in women with cervical insufficiency.

Study design

We conducted an observational study in consecutive women who had preconception LCC. Data was prospectively collected from 55 women at high risk of second trimester miscarriage and extreme preterm delivery due to cervical insufficiency who underwent pre-conception LCC between January 2017 – December 2021. This included patient demographics and relevant obstetric & gynaecological history, previous cervical cerclage, operative complications and subsequent pregnancy outcomes. All women included in study had at least one previous unsuccessful transvaginal cervical cerclage. The surgeries were conducted in private tertiary hospital in Hyderabad, India. The follow-up was until December 2022. The primary outcome was neonatal survival. Surgical morbidity and complications were also recorded.

Results

There were 49 pregnancies of which 46 progressed beyond first trimester. 4.34 % (2/46) were delivered between 28 and 33 weeks due to preterm premature rupture of membranes (PPROM). 13.04 % (6/46) including 5 women with pregnancy complications and one with unicornuate uterus needed delivery between 34 and 36 weeks. 82.60 % (38/46) women were delivered at or beyond 37 weeks of pregnancy. In those who carried pregnancy beyond first trimester, live-birth rate and neonatal survival rate were 100 %. All neonates had favourable outcome with no long-term morbidity. There were no intraoperative or immediate postoperative complications. Two women had long-term complication in the form of tape erosion needing further surgery.

Conclusions

This study provides evidence that LCC improves pregnancy outcomes significantly in those with cervical weakness, without increasing the safety risk.

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CiteScore
2.20
自引率
0.00%
发文量
31
审稿时长
58 days
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