| 王佳佳,赵 纯,李 欣,陈梦茜,谢奇君,李德红,凌秀凤.宫颈环扎术对PCOS双胎妊娠合并宫颈机能不全患者妊娠结局的影响及手术时机研究[J].,2023,(23):4482-4487 |
| 宫颈环扎术对PCOS双胎妊娠合并宫颈机能不全患者妊娠结局的影响及手术时机研究 |
| Study on the Effect of Cervical Cerclage on Pregnancy Outcome and Timing of Surgery in Patients with PCOS Twin Pregnancy Complicate with Cervical Insufficiency |
| 投稿时间：2023-05-27 修订日期：2023-06-23 |
| DOI：10.13241/j.cnki.pmb.2023.23.016 |
| 中文关键词: 多囊卵巢综合征 宫颈机能不全 宫颈环扎术 双胎妊娠 妊娠结局 |
| 英文关键词: Polycystic ovary syndrome Cervical insufficiency Cervical cerclage Twin pregnancy Pregnancy outcome |
| 基金项目:江苏省妇幼保健协会科研课题（FYX202204） |
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| 中文摘要: |
| 摘要 目的：探讨宫颈环扎术对多囊卵巢综合征（PCOS）双胎妊娠合并宫颈机能不全患者妊娠结局的影响及手术时机。方法：回顾性分析2015年01月至2022年06月在南京医科大学附属妇产医院生殖医学中心行冻融胚胎移植后PCOS双胎妊娠合并宫颈机能不全的114例患者的临床资料。按照是否行宫颈环扎术分为手术组和非手术组。根据宫颈环扎手术时间，将行宫颈环扎的PCOS双胎妊娠合并宫颈机能不全患者分为孕周≤16周组和孕周＞16周组。收集患者的临床资料，比较不同组别的临床资料、妊娠结局，分析宫颈环扎术对PCOS双胎妊娠合并宫颈机能不全患者妊娠结局的影响和不同手术时机的治疗效果。结果：PCOS双胎妊娠合并宫颈机能不全患者中67例行宫颈环扎手术，47例未行宫颈环扎手术。手术组晚期流产率低于非手术组，胎膜早破率、产后出血率、剖宫产率、活产率高于非手术组（P＜0.05）。两组妊娠合并症、早产、足月产、新生儿结局组间比较，差异无统计学意义（P＞0.05）。孕周≤16周有33例，孕周＞16周有34例，孕周≤16周组的延长妊娠时间长于孕周＞16周组（P＜0.05）。结论：接受辅助生殖助孕的PCOS患者发生双胎妊娠，在任何孕周发现宫颈扩张并进行经阴道宫颈环扎术均可改善妊娠结局，减少晚期流产的发生，提高活产率，但会增加胎膜早破和产后出血的风险，因此需要做好围手术期的管理。同时在孕周≤16周时行宫颈环扎术可有效延长妊娠时间。 |
| 英文摘要: |
| ABSTRACT Objective: To investigate the effect of cervical cerclage on pregnancy outcome and timing of surgery in patients with polycystic ovary syndrome (PCOS) twin pregnancy complicate with cervical insufficiency. Methods: The clinical data of 114 cases of PCOS twin pregnancy patients with cervical insufficiency after frozen-thawed embryo transfer in Reproductive Medicine Center,Obstetrics and Gynecology Hospital Affiliated to Nanjing Medical University from January 2015 to June 2022 were retrospectively analyzed. Patients were divided into surgical group and non surgical group according to whether cervical cerclage was performed. PCOS twin pregnancy patients with cervical insufficiency who underwent cervical cerclage were divided into gestational age≤16 weeks group and gestational age>16 weeks group according to the surgery time of cervical cerclage. The clinical data of the patients were collected, and the clinical data and pregnancy outcomes of different groups were compared, the effect of cervical cerclage on the pregnancy outcome of PCOS twin pregnancy with cervical insufficiency and the therapeutic effect of different surgical timing were analyzed. Results: Among PCOS twin pregnancy patients with cervical insufficiency, 67 underwent cervical cerclage and 47 did not undergo cervical cerclage. The late abortion rate in surgical group was lower than that in non surgical group, and the premature rupture of membranes rate, postpartum hemorrhage rate, cesarean section rate and live birth rate were higher than those in non surgical group (P<0.05). There was no significant difference in pregnancy complications, premature delivery, full-term delivery and neonatal outcomes between two groups (P>0.05). There were 33 cases of gestational age≤16 weeks, 34 cases of gestational age>16 weeks and prolonged pregnancy time in the gestational age≤16 weeks group was longer than that in gestational age>16 weeks group (P<0.05). Conclusion: Twin pregnancy occurs in PCOS patients undergoing assist reproductive technology, cervical dilatation and transvaginal cervical cerclage at any gestational week can improve pregnancy outcomes, reduce the occurrence of late abortion and increase the live birth rate, but it will increase the risk of premature rupture of membranes and postpartum hemorrhage, perioperative management is needed. Cervical cerclage at gestational age≤16 weeks can effectively prolong pregnancy time at the same time. |
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