Risk Factors For Cervical Insufficiency And Pregnancy Outcomes

Purpose:This study used a retrospective case-control study to analyse the risk factors of cervical insufficiency,and the cases further more the cervical insufficiency in patients with emergency cerclage pregnant women and preventive cerclage pregnancy outcomes.In order to investigate the cervical cerclage technique to implement the timing of the impact on the pregnancy outcome of early pregnant women to improve cervical insufficiency,the screening rate and diagnosis rate,and seize the opportunities to prevent miscarriage and premature birth.Methods:1.Collect 264 cases of pregnant women(both for the patients with single pregnancy)are admissed and delivered in Shandong Province Qqianfoshan Hospital form January 2015 to December 2017.There are 132 cases of cervical insufficiency who include 118 cases of pregnant women are accepted the cure of surgery,according to the operation time divided into emergency cervical cerclage group 81 examples,prevent cervical cerclage group of 37 cases(the number of stress cervical cervix cerclage is small and not be analyzed)divide two groups.There were 132 cases in the normal control group(randomly selected),and the difference in age between the case group and the control group was no significance.2.Basic data of all pregnant women,including age,BMI before pregnancy,number of pregnancies,number of births,number of miscarriages,history of cesarean section,history of preterm birth,history of hysterectomy,uterine deformity(all types of deformity were bilateral uterine),history of emergency labor and history of prolonged second labor.Obstetric complications,premature rupture of membranes(premature rupture of membranes PROM)Gestational hypertension disease(hypertensive disorder complicating pregnancy),Gestational Diabetes(Gestational Diabetes.GDM),placental abruption,placental abruption),placental abruption,placenta previa),polycystic ovary syndrome(polycystic ovarian syndrome PCOS),cervical cone cutting history,assisted reproductive technology(assisted reproductive technology ART);basic clinical data,including weeks of pregnancy,extended delivery time,weeks of pregnancy;And intraoperative and postoperative conditions,including operation time,postoperative diseases,length of hospital stay,termination of pregnancy,preoperative and postoperative blood C-reactive protein(CRP);Neonatal survival rate,Apgar score 1 minute after birth,birth weight of live infants;clinical auxiliary examination,including preoperative cervical canal length and closure of the cervix is collected.Through comparison and analysis,we can acquier the risk factors of cervical insufficiency in pregnant women and compare the perinatal outcomes and clinical effects of cervix ligation when the operation timing conditions.differents.Results:1.The comparative about the patients’ basic information between the case group and control group was:the age and number of pregnancies between two groups had no statistically significiant difference(P>0.05).The number of delivery times was 2.70±1.403 VS 1.92±1.082,and the mean spontaneneous adortion time was 3.15±0.868 VS 2.35±0.919),the BMI before pregnancy was 25.50±3.42 VS 23.64 ±3.59,respectively which had statistically significiant difference(P<0.05).2.Univariate analysis of high risk factors of pregnant women in case group and control group:Comparison of high-risk factors between the two groups included:BMI before pregnancy,history of cervical cone resection,history of preterm birth,bilateral horn uterus,assisted reproductive technology,placenta previa,polycystic ovary,history of cesarean section,history of uterine clearance,history of prolonged second labor,and incidence of emergency labor,with statistically significant differences(P<0.05).3.Logistic regression analysis:The results of Logistic regression analysis showed that the risk factors of cervical insufficiency in pregnant women were:history of preterm birth,bilateral horn uterus,cervical cone resection history,polycystic ovary,assisted reproductive technology,prolongation of the second stage of labor,rapid labor,and history of hysterectomy(OR=2.958,95%CI为 0.182-0.627,P<0.05;OR =10.752,95%CI 0.012-0.738,P<0.05;OR=4.739,95%CI 为 0.069-0.647,P<0.05;OR=9.615,95%CI为 0.013-0.836,OR=10.000;95%CI 为 0.029-0.339;OR=3.164,95%CI 为 0.161-0.620;OR=6.451,95%为 0.062-0.368;OR=2.445,95%CI为 0.233-0.717).4.Comparison of pregnancy outcomes between the case group and the control group:92(69.70%)subjects had low-weight births in the case group and 13(9.85%)subjects in the control group.The difference between the two groups was statistically significant(P<0.05).In the case group,28(21.21%)subjects hadasphyxia neonatorum and 18(13.64%)subjects neonatal deaths.And there are 8(6.06%),and 0 neonatal deaths in the control group.They have statistically significant difference(P<0.05).5.The prolong gestational age and preganancy outcomes between ECC and prevent cervical cerclage group:emergency cervix cerclage group prolong gestational age was 49.15±21.32 days,the prevention cervix cerclage group prolong gestational age was 133.54 34.15 days,which the difference was statistically significant(P<0.05).Two groups of full term births(3.70%VS 48.65%),greater than 28 weeks(71.60%VS 97.30%),greater than 32 weeks(43.21%VS 91.90%),and greater than 34 weeks(22.22%VS 67.57%)were statistically significant(P<0.05).And the neonatal mortality(21.00%vs.2.70%),neonatal Apagar score(6.68±3.87 vs.9.19±1.79),and neonatal weight(1930.75±1283.90g vs.3008.16±818.22g)were statistically significant between the two groups(P<0.05).6.To compare the complications of ECC group and the prevention cervix cerclage group:2 cases(5.41%)of cervix laceration,3 cases(8.10%)of Chorionic amnionitis,l case(2.70%)of Premature rupture of membranes occurred in the prevention cervix cerclage group;17 cases(20.99%)of cervix laceration,23 cases(28.40%)of chorionic amnion,20 cases(24.69%)in Premature rupture of membranes occurred in the ECC group,the difference had statistical significance.(P<0.05).Conclusion:1.Risk factors for cervical insufficiency include:history of preterm labor,double horns,and the history cervical conization,history of polycystic ovary,assisted reproductive technology,urgent production,the second prolonged labor history,uterine curettage.Pay attention to the prenatal care of patients with these risk factors,we can screen out the lurking in normal pregnant women in the high-risk groups to improve the diagnostic rate and improve among.2.The prevention cervix cerclage is superior to ECC in terms of prolonging pregnancy week,reducing abortion rate and reducing neonatal mortality,so intervention measures before cervical changes can effectively improve perinatal outcomes.