Analysis of Efficacy of Cervical Cerclage via Different Approaches in the Treatment of Twin Pregnancy Complicated With Cervical Insufficiency
10.3969/j.issn.1009-6604.2025.03.007
- VernacularTitle:不同路径宫颈环扎术治疗双胎妊娠合并宫颈功能不全的疗效分析
- Author:
Sifan LI
1
;
Xiaoyan YING
1
Author Information
1. 南京医科大学第二附属医院妇产科,南京 210003
- Publication Type:Journal Article
- Keywords:
Cervical insufficiency;
Transvaginal cervical cerclage;
Laparoscopic cervical cerclage;
Twin pregnancy
- From:
Chinese Journal of Minimally Invasive Surgery
2025;25(3):164-170
- CountryChina
- Language:Chinese
-
Abstract:
Objective To investigate effects of prophylactic laparoscopic and transvaginal cervical cerclage in the treatment of twin pregnancy complicated with cervical insufficiency.Methods A retrospective analysis was performed on 57 patients with twin pregnancy complicated with cervical insufficiency undergoing elective surgery from March 2021 to April 2024.The patients were fully informed of two surgical methods and their advantages and disadvantages before surgery.According to the patient's wishes,26 cases underwent transvaginal cervical cerclage(vaginal cerclage group)and 31 cases underwent laparoscopic cervical cerclage(abdominal cerclage group).The operation time,intraoperative blood loss and other surgery-related conditions,pregnancy outcomes such as gestational age of delivery and incidence of spontaneous miscarriage,neonatal prognosis such as neonatal birth weight and the Apgar score,and complications of childbirth such as cervical laceration,premature rupture of membranes,chorioamnionitis were compared between the two groups.Results No serious complications occurred in both groups.The operation time[(62.8±19.0)min vs.(79.7±20.5)min,t=-3.212,P=0.002]and intraoperative blood loss[15(10,20)ml vs.50(20,50)ml,Z=-3.757,P=0.000]in the vaginal cerclage group were less than those in the abdominal cerclage group.There were no significant differences in hospital stay,incidence of postoperative premature rupture of membranes,and postpartum hemorrhage between the two groups.The incidence of chorioamnionitis in the vaginal cerclage group was significantly higher than that in the abdominal cerclage group[19.2%(5/26)vs.0.0%(0/31),P=0.016].The prolong gestational weeks in the abdominal cerclage group were longer than those in the vaginal cerclage group[(21.9±4.4)gestational weeks vs.(18.6±5.8)gestational weeks,t=-2.377,P=0.021].The delivery rate<32 gestational weeks in the abdominal cerclage group was significantly lower than that in the vaginal cerclage group[6.5%(2/31)vs.30.8%(8/26),χ2=4.222,P=0.040].Compared with the vaginal cerclage group,the abdominal cerclage group had higher birth weight[(2247.4±370.3)g vs.(2037.5±542.0)g,t=-2.289,P=0.025],1-minute Apgar score[(8.9±1.1)points vs.(7.9±1.8)points,t=-3.130,P=0.002]and 5-minute Apgar score[(9.4±0.7)points vs.(8.9±1.2)points,t=-2.912,P=0.004],and lower incidences of 5-minute Apgar score≤7 points[1.7%(1/60)vs.18.8%(9/48),χ2=7.341,P=0.007],neonatal intensive care unit admission[28.3%(17/60)vs.60.4%(29/48),χ2=11.226,P=0.000]and hyperbilirubinemia[21.7%(13/60)vs.43.8%(21/48),χ2=6.029,P=0.014].Conclusions Prophylactic transvaginal cervical cerclage and laparoscopic cervical cerclage are both safe and effective for twin pregnancy complicated with cervical insufficiency.Compared with transvaginal cervical cerclage,laparoscopic cervical cerclage can reduce the incidence of postoperative chorioamnionitis,prolong the gestational week of delivery,reduce the risk of spontaneous preterm birth<32 gestational weeks,and achieve better pregnancy outcomes and neonatal prognosis.
