Risk Factors Of Short Cervical Length Of Pregnancy In Patients With Recurrent Spontaneous Abortion In The First Trimester And Exploration On The Monitoring Mode Of Cervical Length

Objective: To explore the risk factors of short cervical length in the second trimester of pregnancy in patients with recurrent spontaneous abortions in the first trimester and to explore the monitoring mode of cervical length during pregnancy.Methods: From October 2016 to September 2020,149 early pregnant women in recurrent spontaneous abortion clinic of Shengjing Hospital affiliated to China Medical University with a history of recurrent spontaneous abortion in the first trimester were selected.Their cervical length were monitored by two monitoring modes(routine monitoring mode: cervical length was measured only once at 18-24 weeks of pregnancy,sequential monitoring mode: cervical length was measured from4 weeks / 2 weeks to 28 weeks from 14 weeks of pregnancy.)The patients with short cervical length were selected as the study group(n = 36)and those without cervical shortening as the control group(n = 113).The medical history,clinical and laboratory results of the two groups were analyzed,and univariate and multivariate Logistic regression analysis was carried out.Among the 36 patients with short cervical length,13 cases underwent routine monitoring of cervical length,including 7 cases of cervical cerclage(3 cases of emergency cervical cerclage and 4 cases of acute cervical cerclage)and 1 case of late abortion(26W+5).The cervical length was monitored sequentially(4 weeks / 2 weeks)in 23 cases,including 9 cases of cervical cerclage(9cases of emergency cervical cerclage and 0 cases of acute cervical cerclage)and 2cases of premature delivery(31W+4 and 33W+4).The different cervical ligation methods and pregnancy outcomes under the two monitoring modes were compared.Results: Univariate analysis show that uterine adhesion,induced abortion ≥ 4 times and hysteroscopic operation ≥ 3 times were related to short cervical length(P < 0.05).Multivariate Logistic regression analysis show that more than induced abortion ≥ 4times(OR=5.134,95%CI1.173-22.473)and hysteroscopic operation ≥ 3 times(OR=5.005,95%CI2.164-11.576)were associated with short cervical length.Compared with sequential cervical length monitoring,Fisher’s test showed that emergency cervical circular ligation was needed when cervical shortening was found by routine cervical length monitoring,and there was no significant difference in pregnancy outcome between the two cervical length monitoring methods(P < 0.01).The results of Fisher’s test showed that emergency cervical circular ligation was needed when cervical shortening was found by routine cervical length monitoring,and there was no significant difference in pregnancy outcome between the two cervical length monitoring methods(P < 0.01).The Fisher’s test of the two cervical cerclage for monitoring cervical length show that compared with the sequential monitoring of cervical length,the routine monitoring of cervical length need emergency cervical cerclage(P < 0.05).Conclusion: More than 4 times of induced abortions and more than 3 times of hysteroscopic operations are independent risk factors for short cervical length in patients with recurrent spontaneous abortions in the first trimester of pregnancy.It is suggested that for patients with recurrent spontaneous abortions in the first trimester and high risk factors,short cervical length can be detected more timely by sequential(4 weeks / 2 weeks)transvaginal ultrasound monitoring of cervical length in 14-28 weeks of pregnancy and reduce the risk of emergency cervical ligation and surgical failure.Although the pregnancy outcome under the two modes of monitoring cervical length was not statistically significant,the gestational week of delivery with sequential transvaginal ultrasound monitoring was significantly higher than that of routine monitoring of cervical length.