Clinical Analysis Of McDanold Cervical Cerclage In The Treatment Of Cervical Insufficiency

Objective:Analyze the clinical data of patients with cervical insufficiency,explore the effectiveness of McDanold cervical cerclage,and compare the timing of cerclage and its influence on maternal and infant outcomes.Method:Collected the clinical data of 220 cases of pregnant women diagnosed with cervical insufficiency by the Second Hospital of Jilin University from January 2015 to January 2020.According to different treatment methods,they were divided into conservative treatment group(60 cases)(mainly bed rest)and surgery treatment group(160 cases)(McDanold cervical cerclage);the surgical treatment group was divided into prophylactic cervical cerclage group(85 cases),therapeutic cervical cerclage group(58 cases)and emergency cervical cerclage group(17cases)according to the different operative timing;the prophylactic cervical cerclage group was divided into 1 abortion / preterm birth group(46 cases),2 abortion / preterm birth group(28 cases)and ≥3 abortion /preterm birth group(7 cases)according to the previous times of mid-late abortion or premature birth.Analyze and compare the general data,pregnancy data and maternal and infant outcomes among different groups,explore the clinical efficacy of McDanold cervical cerclage,and compare the operation timing of cerclage and its influence on maternal and infant outcomes.The patient’s general information includes age,BMI,number of pregnancy,number of births,number of previous miscarriages or preterm births,and the method of conception.Pregnancy information includes the cervical length,diagnosis/cerclage gestational age,delivery gestational ages,extended gestational ages.Pregnancy outcomes include abortion rate,preterm birth rate,term birth rate and live birth rate.The status of the live infant included the weight of live infants,1-minute Apgar score and 5-minute Apgar score.Complications include chorioamnionitis,cervical laceration and premature rupture of membranes.Statistical software SPSS 25.0 was used to analyze the clinical data of pregnant women included in this study.Result:1.Compared with the cerclage group and the conservative group,there were no significant differences in the age,BMI,number of births,number of pregnancy,number of previous miscarriages or preterm births,method of conception,cervical length,diagnosis/cerclage gestational age,abortion rate,incidence of chorioamnitis and cervical laceration between the two groups(P > 0.05).delivery gestational ages,extended gestational ages,preterm birth rate,term birth rate,live birth rate,the weight of live infants,1-minute Apgar score,5-minute Apgar score,delivery method and incidence of premature rupture of membranes were compared between the two groups,and the difference was statistically significant(P<0.05).2.Comparing the prophylactic cerclage group,the therapeutic cerclage group and the emergency cerclage group,there were no significant differences in the age,BMI,number of births,method of conception,preterm birth rate,live birth rate,delivery method,the incidence of chorioamnionitis and cervical laceration among the three groups(P > 0.05).The three groups were compared in terms number of pregnancy,number of previous miscarriages or preterm births,cervical length,cerclage gestational age,delivery gestational ages,extended gestational ages,abortion rate,term birth rate,the weight of live infants,1-minute Apgar score,5-minute Apgar score,and incidence of premature rupture of membranes,and the difference was statistically significant(P <0.05).3.Comparing the 1 abortion / preterm birth group,2 abortion /preterm birth group and ≥3 abortion / preterm birth group,there were no significant differences in the age,BMI,number of births,method of conception,cervical length,cerclage gestational age,delivery gestational ages,extended gestational ages,abortion rate,preterm birth rate,term birth rate,live birth rate,the weight of live infants,1-minute Apgar score,5-minute Apgar score,delivery method and incidence of chorioamnitis,cervical laceration and premature rupture of membranes among the three groups(P > 0.05).The number of pregnancies in the three groups was compared,and the difference was statistically significant(P < 0.05).The number of pregnancies in the group with 1 abortion history was lower than that in the other two groups,and the difference was statistically significant(P < 0.001).There was no statistically significant difference in the number of pregnancies in the group with 2 abortion history and the group with ≥3 abortion history(P > 0.05).Conclusion:1.Compared with conservative treatment,McDanold cervical cerclage significantly prolongs the pregnancy time,increases the term birth rate and live birth rate,and improves the neonatal outcome;but cervical cerclage increases the rate of cesarean section and premature rupture of membranes.2.The pregnancy outcome and the conditions of neonatal between prophylactic and therapeutic cervical cerclage are similar;emergency cervical cerclage can also prolong the gestational week and improve the maternal and infant outcome,but the incidence of abortion and premature rupture of membranes is higher.3.Patients with a history of one or more mid-to-late miscarriage or premature delivery may benefit from prophylactic cervical ligation.