Background

Cervical cerclage is the only effective treatment for cervical insufficiency, effectively preventing late miscarriage and preterm birth. The effectiveness and safety of emergency cervical cerclage (ECC) as an emergency treatment when the cervix is already dilated or when there is protrusion of the fetal membranes into the vagina remain controversial, especially in pregnancies at 24–28 weeks when the fetus is viable. There is still no consensus on whether emergency cervical cerclage should be performed in such cases.

Purpose

To investigate the effectiveness and safety of emergency cervical cerclage in singleton pregnant women at 24–28 weeks of gestation.

Methods

This study employed a single-center prospective cohort design, enrolling singleton pregnant women at 24–28 weeks of gestation with ultrasound or physical examination indicating cervical dilation or even membrane protrusion. Emergency cervical cerclage was compared with conservative treatment. The primary endpoints included a comprehensive assessment of perinatal pregnancy loss, significant neonatal morbidity, and adverse neonatal outcomes. Secondary endpoints included prolonged gestational age, preterm birth, neonatal hospitalization rate, premature rupture of membranes, and intrauterine infection/chorioamnionitis.

Results

From June 2021 to March 2023, a total of 133 pregnant women participated in this study, with 125 completing the trial, and were allocated to either the Emergency Cervical Cerclage (ECC) group (72 cases) or the conservative treatment group (53 cases) based on informed consent from the pregnant women. The rate of adverse neonatal outcomes was 8.33% in the ECC group and 26.42% in the conservative treatment (CT) group, with a statistically significant difference (P = 0.06). There were no significant differences between the two groups in terms of perinatal pregnancy loss and significant neonatal morbidity. The conservative treatment group had a mean prolonged gestational age of 63.0 (23.0, 79.5) days, while the ECC group had 84.0 (72.5, 89.0) days, with a statistically significant difference between the two groups (P < 0.001). Compared with CT group, the ECC group showed a significantly reduced incidence of preterm birth before 28 weeks, 32 weeks, and 34 weeks, with statistical significance (P = 0.046, 0.007, 0.001), as well as a significantly decreased neonatal hospitalization rate (P = 0.013, 0.031). Additionally, ECC treatment did not increase the risk of preterm premature rupture of membranes or intrauterine infection/chorioamnionitis, with no statistically significant differences (P = 0.406, 0.397).

Conclusion

In singleton pregnant women with cervical insufficiency at 24–28 weeks of gestation, emergency cervical cerclage can reduce adverse neonatal pregnancy outcomes, effectively prolong gestational age, decrease preterm births before 28 weeks, 32 weeks, and 34 weeks, lower neonatal hospitalization rates, and does not increase the risk of preterm premature rupture of membranes or intrauterine infection/chorioamnionitis.

中文翻译：

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妊娠 24-28 周单胎妊娠紧急宫颈环扎术的围产期结局分析

背景

宫颈环扎术是治疗宫颈机能不全的唯一有效治疗方法，可有效预防晚期流产和早产。当子宫颈已经扩张或胎膜伸入阴道时，紧急宫颈环扎术（ECC）作为紧急治疗的有效性和安全性仍然存在争议，特别是在胎儿存活的 24-28 周妊娠中。对于此类病例是否应行紧急宫颈环扎术，目前尚未达成共识。

目的

探讨妊娠 24-28 周单胎孕妇紧急宫颈环扎术的有效性和安全性。

方法

本研究采用单中心前瞻性队列设计，纳入妊娠24-28周的单胎孕妇，超声或体检显示宫颈扩张甚至胎膜突出。将紧急宫颈环扎术与保守治疗进行比较。主要终点包括对围产期妊娠丢失、新生儿显着发病率和新生儿不良结局的综合评估。次要终点包括孕龄延长、早产、新生儿住院率、胎膜早破和宫内感染/绒毛膜羊膜炎。

结果

从2021年6月至2023年3月，共有133名孕妇参与了这项研究，其中125名完成了试验，并被分配到紧急宫颈环扎术（ECC）组（72例）或保守治疗组（53例）基于孕妇的知情同意。 ECC组新生儿不良结局发生率为8.33%，保守治疗（CT）组新生儿不良结局发生率为26.42%，差异有统计学意义（P  =0.06）。两组之间在围产期妊娠丢失和显着新生儿发病率方面没有显着差异。保守治疗组平均孕龄延长为63.0（23.0，79.5）天，ECC组为84.0（72.5，89.0）天，两组比较差异有统计学意义（P  < 0.001）。与 CT 组相比，ECC 组 28 周、32 周、34 周前早产发生率显着降低，差异有统计学意义（P  = 0.046、0.007、0.001），新生儿住院率也显着降低（P  = 0.013, 0.031)。此外，ECC治疗并没有增加胎膜早破或宫内感染/绒毛膜羊膜炎的风险，没有统计学上的显着差异（P  = 0.406，0.397）。

结论

对于孕24~28周宫颈机能不全的单胎孕妇，紧急宫颈环扎术可减少新生儿不良妊娠结局，有效延长孕周，减少28周、32周、34周前早产，降低新生儿住院率，降低新生儿住院率。不会增加胎膜早破或宫内感染/绒毛膜羊膜炎的风险。