Short cervical length by ultrasound and cerclage

被引：32

作者：

Hibbard J.U. ^{[1
,2
]}

Snow J. ^{[1
]}

Moawad A.H. ^{[1
]}

机构：

[1] Dept. of Obstetrics and Gynecology, Pritzker School of Medicine, University of Chicago, Chicago, IL

[2] Dept. of Obstetrics and Gynecology, University of Chicago, MC 2050, Chicago, IL 60637

来源：

Journal of Perinatology | 2000年 / 20卷 / 3期

关键词：

D O I：

10.1038/sj.jp.7200333

中图分类号：

学科分类号：

摘要：

OBJECTIVE: To determine whether gravidas with short cervical length on endovaginal ultrasound examination, not in preterm labor, who underwent cervical cerclage have better outcomes compared with those with no cerclage. METHODS: This is an observational study in which data were collected prospectively on women who had ultrasound endovaginal cervical length measurement and were not in preterm labor. The subgroup of women who were ≤26 weeks' at cervical measurement was analyzed separately. Short cervix was defined as ≤30 mm. After delivery, charts were reviewed for management and outcomes, performed at the discretion of the attending obstetrician. Two study groups were defined: those with cerclage and those with no cerclage. Predictor variables were cerclage and cervical lengths. Outcome variables were birth weight, gestational age at delivery, and neonatal outcomes. Data were analyzed using the χ-squared, Fisher's exact, and Student's t-tests, a/p value of <0.05 was considered to be significant. RESULTS: A total of 85 patients with cervical lengths of ≤30 mm were identified; of these 43 had cerclage, and 42 did not The latter had bedrest, tocolytics, or no intervention. Indications for cervical length measurement were similar in both groups, as were age, insurance status, cervical measurements, preterm premature rupture of membranes, and mode of delivery. The mean gestational age at delivery and birth weight in the cerclage group (34.0 ± 5.4 weeks'; 2530 ± 905 gm) were greater than in the no cerclage group (32.0 ± 6.0 weeks', 2084 ± 1085 gm,p values of <0.04 and <0.04, respectively). Analysis for the subgroup of women who were ≤26 weeks' at first measurement revealed similar results. The relative risk for delivering at <30 weeks' gestation, for incrementally shorter cervices, was less in the cerclage group. CONCLUSION: Cerclage in gravidas with short cervix measured by endovaginal ultrasound, not in preterm labor, may be associated with neonates of greater gestational age and birth weight, with fewer of these parturients delivering before 30 weeks' gestation. A prospective randomized trial of treatment modalities for asymptomatic shortened cervix is needed.

引用

页码：161 / 165

页数：4

共 11 条

[1]

Anderson H.F., Nugent C.E., Wanty S.D., Hayashi R.H., Prediction of risk for preterm delivery by ultrasonographic measurement of cervical length, Am J Obstet Gynecol, 163, pp. 859-867, (1990)

[2]

Iams J., Paraskos J., London M.B., Teteris J.N., Johnson F.F., Cervical sonography in preterm labor, Obstet Gynecol, 84, pp. 40-46, (1994)

[3]

Murakawa H., Utumi T., Hasegawa I., Tanaka K., Fuzimori R., Evaluation of threatened preterm delivery by transvaginal ultrasonographic measurement of cervical length, Obstet Gynecol, 82, pp. 829-832, (1993)

[4]

Iams J.D., Goldenberg R.L., Meis P.J., Et al., The length of the cervix and the risk of spontaneous premature delivery, N Engl J Med, 334, pp. 567-572, (1996)

[5]

Iams J.D., Johnson F.F., Sonek J., Sachs L., Gebauer C., Samuels P., Cervical competence as a continuum: A study of ultrasonographic cervical length and obstetric performance, Am J Obstet Gynecol, 172, pp. 1097-1106, (1995)

[6]

Grant A.M., Cervical cerclage, Pregnancy and Childbirth Module, Cochrane Database of Systematic Reviews, (1994)

[7]

Taipale P., Hilesmaa V., Sonographic measurement of uterine cervix at 18-22 weeks' gestation and the risk of preterm delivery, Obstet Gynecol, 92, pp. 902-907, (1998)

[8]

Sonek J., Blumenfeld M., Foley M., Johnson F., Iams J., Cervical length may change during ultrasonographic examination, Am J Obstet Gynecol, 162, pp. 1355-1357, (1990)

[9]

Quinn M.J., Vaginal ultrasound and cervical cerclage: A prospective study, Ultrasound Obstet Gynecol, 2, pp. 410-416, (1992)

[10]

Guzman E.R., Rosenberg J.C., Houlihan C., Ivan J., Waldron R., Knuppel R., A new method using vaginal ultrasound and transfundal pressure to evaluate the asymptomatic incompetent cervix, Obstet Gynecol, 83, pp. 248-252, (1994)

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