7.Analysis of clinical effect of cervical cerclage in twin pregnancies with cervical length ≤15 mm at different gestational ages
Chinese Journal of Obstetrics and Gynecology 2025;60(2):99-104
Objective:To investigate the clinical effect of cervical cerclage at different gestational weeks in twin pregnancy with cervical length (CL)≤15 mm.Methods:This was a retrospective cohort study. Eighty-three twin pregnant women with CL≤15 mm detected by transvaginal ultrasound at 16-27 +6 weeks of gestation in Fujian Maternity and Child Health Hospital from January 2017 to December 2023 were enrolled. According to different treatment methods, they were divided into cervical cerclage group (47 cases) and conservative treatment group (36 cases), and stratified according to the gestational age of CL≤15 mm diagnosis (<26 weeks, ≥26 weeks). The differences in pregnancy outcomes between the two groups were compared. Multivariate logistic regression was used to analyze the effect of cervical cerclage on preterm birth in twin pregnant women with different CL≤15 mm diagnosis weeks. Results:(1) The gestational age at delivery and prolonged gestational age in the cervical cerclage group were longer than those in the conservative treatment group (median gestational age at delivery: 35.3 vs 33.0 weeks; median prolonged gestational age: 10.4 vs 7.2 weeks), and preterm birth rates before 34, 32 and 28 weeks were lower than those in the conservative treatment group [34 weeks: 23% (11/47) vs 53% (19/36); 32 weeks: 15% (7/47) vs 39% (14/36); 28 weeks: 4% (2/47) vs 25% (9/36)], the differences were statistically significant (all P<0.05). There were no significant differences in the rates of preterm birth before 37 weeks of gestation and preterm premature rupture of membranes between the two groups (all P>0.05). (2) When gestational age at CL≤15 mm diagnosis was <26 weeks, pregnancy outcomes in the cervical cerclage group were better than those in the conservative treatment group, including gestational age at delivery (median: 35.4 vs 31.3 weeks) and prolonged gestational age (median: 11.1 vs 5.6 weeks), neonatal birth weight [(2 246±519) vs (1 594±691) g], incidence of adverse neonatal outcomes [19% (13/68) vs 56% (19/34)], and proportion of live births [100% (68/68) vs 82% (28/34)], respectively; the differences were statistically significant (all P<0.05). When the gestational age of CL≤15 mm diagnosis was ≥26 weeks, there were no statistically significant difference in pregnancy outcomes between the two groups (all P>0.05). (3) Multivariate logistic regression analysis showed that when the gestational age of CL≤15 mm diagnosis was <26 weeks, cervical cerclage reduced the risk of preterm birth before 34 weeks (a OR=0.10, 95% CI: 0.02-0.51; P<0.05), 32 weeks (a OR=0.11, 95% CI: 0.02-0.58; P<0.05) and 28 weeks (a OR=0.04, 95% CI: 0.01-0.65; P<0.05). When the gestational age of CL≤15 mm diagnosis was ≥26 weeks, cervical cerclage did not reduce the risk of preterm birth before 34, 32 and 28 weeks of gestation (all P>0.05). Conclusions:Cervical cerclage might reduce the risk of preterm birth and improve neonatal outcomes in twin pregnancies with CL≤15 mm before 26 weeks. However, cerclage showed no advantage over conservative treatment in twin pregnancies with CL≤15 mm over 26 weeks.
8.Clinical study of modified cervical cerclage at different surgical timings in twin pregnant women with cervical insufficiency
Yanwei FAN ; Guangcai ZHAO ; Siyuan YANG ; Wenhui CHEN ; Ningning ZHAO ; Haiying LIU
Chinese Journal of Obstetrics and Gynecology 2025;60(2):105-113
Objective:To explore the clinical efficacy of three different surgical timings of modified cervical cerclage in twin pregnant women with cervical insufficiency.Methods:The clinical data of 73 twin pregnant women who underwent modified cervical cerclage and had pregnancy outcomes in Qilu Hospital of Shandong University (Qingdao) from April 2014 to July 2023 were retrospectively analyzed. According to the different timings of surgery, they were divided into prophylactic cerclage group, ultrasound-indicated cerclage group (further divided into cervical length (CL)≤15 mm and 15 mm
9.Value of high-risk HPV viral load in cervical cancer screening and triage: a real world retrospective study based on cervical cancer screening program in Quanzhou, China
Yuanqin CHEN ; Qiumei HUANG ; Meiling HONG ; Yuqin ZHU ; Yanling GAO ; Liyun CHEN ; Liying CHEN
Chinese Journal of Obstetrics and Gynecology 2025;60(3):193-201
Objective:To evaluate the clinical value of high-risk human papillomavirus (HPV) viral load for the cervical cancer screening and triage of high-risk HPV positive populations without additional tests.Methods:(1) This study conducted a retrospective analysis of 29 720 women aged 35-64 years who received cervical cancer screening in Quanzhou, China, in 2021. Fourteen high-risk HPV types (including HPV 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 66, and 68) were detected for cervical cancer primary screening using hybrid capture-chemiluminescence method. High-risk HPV positive samples were further subjected to HPV 16/18 genotyping using hybrid capture-chemiluminescence method. Among them, HPV 16/18 positive women were directly referred to colposcopy, while the other 12 high-risk HPV positive samples were further subjected to liquid based cytology test. Those with abnormal or suspicious cytology were referred to colposcopy. Biopsies were taken for histopathological examination of suspicious or abnormal individuals under colposcopy. (2) Ten cases of colposcopy loss or refusal to undergo examination were excluded, and the data from the 29 710 cases were analyzed. The HPV viral loads of the other 12 high-risk HPV positive populations were focused and evaluated their HPV viral loads for further cervical intraepithelial neoplasia (CIN) Ⅱ and above lesions (CINⅡ +) triage in cervical cancer screening. Results:(1) Among 29 720 women, 2 487 women (8.37%, 2 487/29 720) were positive for high-risk HPV, including 807 women (2.72%, 807/29 720) were positive for HPV 16/18 and 1 680 patients (5.65%, 1 680/29 720) were positive for the other 12 high-risk HPV types. Among 1 680 women who tested positive for the other 12 high-risk HPV types, 573 patients were atypical squamous cell carcinoma of unclear significance or above, 346 patients were CIN Ⅰ, 122 patients were CIN Ⅱ-Ⅲ, 9 patients were squamous cell carcinoma patients, and 4 patients were adenocarcinoma in situ. The immediate risk of CIN Ⅱ + in HPV 16/18 positive women (11.13%) was approximately four times higher than that of other 12 high-risk HPV positive women (2.74%). (2) Through the viral load analysis of the other 12 high-risk HPV types, we found that the viral load of the other 12 high-risk HPV provide a good value for the pathological results, with a clinical cutoff (CO) value of 11.21 relative light unit/CO (RLU/CO) for the CINⅡ + detection. Except for HPV 16/18 positive patients, when the viral load values of the other 12 high-risk HPV types were greater than 10 RLU/CO, these patients had a higher risk of CINⅡ +, with a positive predictive value of 31.29%. CINⅡ + was not found in any of the other 12 high-risk HPV positive with viral load values less than or equal to 10 RLU/CO. Conclusions:Using hybrid capture-chemiluminescence HPV tests for HPV 16/18 genotyping, combined with the viral loads (>10 RLU/CO) of the other 12 high-risk HPV analysis, one could triage HPV positive population without additional tests. Such triage strategy could promote the coverage of cervical cancer screening, particularly where cytology pathologists or economic resources are limited.
10.Carrier screening and prenatal diagnosis analysis of high-risk cases in 3 044 preconception and early pregnancy couples
Xiaolin FU ; Wei HOU ; Manli ZHANG ; Xiaoxiao XIE ; Yan MENG ; Honghui ZHOU ; Qingdong ZHAO ; Jialin HU ; Guiping MO ; Yanping LU
Chinese Journal of Obstetrics and Gynecology 2025;60(3):161-170
Objective:To carry out carrier screening among people of childbearing age, detect the pathogenic genes of monogenic genetic diseases and analyze the carrier status of pathogenic variants, so as to provide fertility guidance and intervention measures for high-risk families.Methods:From August 2022 to August 2023, 1 533 families of childbearing age who met the criteria were recruited in the Chinese PLA General Hospital, including a total of 3 044 subjects. According to the standard enrollment procedure, 223 genes (197 autosomal recessive genes and 26 X-linked genes) of the subjects were tested. According to the screening results, genetic counseling and fertility guidance were provided to the subjects. Invasive prenatal diagnosis was performed for high-risk couples (both couples being carriers of the same autosomal recessive disease gene or the woman was a carrier of X-linked disease gene), and their pregnancy pattern, outcome and offspring phenotype were followed up.Results:(1) A total of 3 044 cases from 1 511 couples and women of childbearing age from 22 families were included for carrier screening. Totally 1 503 families chose simultaneous screening and 30 families chose sequential screening out of the 1 533 families. Among the 3 044 subjects, 1 603 individuals carried at least one pathogenic or likely pathogenic variant, and the overall carrier rate was 52.66% (1 603/3 044). A total of 2 292 pathogenic or likely pathogenic variants were detected, and 0.75 variants (2 292/3 044) were detected per capita. (2) The three genes with the highest carrier rates were GJB2 (8.67%, 264/3 044), CYP21A2 (3.19%, 97/3 044) and PAH (3.09%, 94/3 044). There were 32 genes with a carrier rate ≥1/200, 17 genes with a carrier rate ≥1/100, and 7 genes with a carrier rate ≥1/50. (3) Thirty-eight high-risk families were identified. After excluding G6PD gene mutation, there were 33 high-risk families, of which 25 couples were carriers of the same autosomal recessive gene, 9 women were carriers of X-linked gene, and 1 family was double high-risk couple with both autosomal recessive and X-linked gene. After further excluding the GJB2 c.109G>A mutation, 21 high-risk families were identified. Preimplantation genetic testing for monogenic disease was performed in 12 families after genetic counseling. Prenatal diagnosis was completed in 4 out of 5 high-risk families who conceived naturally. Two fetuses carried the parental variants and terminated the pregnancy, one fetus did not carry the parental variants but was induced due to trisomy 21 syndrome, and one fetus was a carrier of congenital disorders of glycosylation type 1a.Conclusions:Carrier screening effectively identifies high-risk genetic disease families and provides reproductive guidance to prevent the birth of affected children. However, establishing multidisciplinary team is essential for managing complex cases. Implementation should prioritize prenatal institutions with genetic counseling or diagnostic expertise for monogenic disorders or established referral networks.
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